Health

Call for more training to improve blood tests in A&E

Blood test
Image caption Can doctors take a blood sample?

Scientists say doctors need better training to avoid mistakes in blood samples taken in hospital A&E departments.

The warning from the Association for Clinical Biochemistry follows an audit at Birmingham City Hospital.

The trust has put in place extra training, but the ACB says this is a problem across the UK.

The College of Emergency Medicine says it is essential that staff use the right technique to collect blood.

Blood test results are often key to assessing patients when they arrive in A&E. But staff are frequently working under extreme pressure.

The ACB is worried that this contributes to errors when they take blood samples.

The concerns are highlighted by the Birmingham audit of samples collected by a range of junior doctors and nurses.

Urgent cases

In the study, published in the Annals of Clinical Biochemistry, the researchers followed the collection of 50 samples from some of the most urgent cases, over a two week period.

More than half were taken using the wrong equipment. They should normally by collected into vacuum tubes with special needles rather than using syringes which can damage fragile blood cells.

The researchers also found that about half the samples were mishandled for testing, raising the risk of contamination.

The trust has arranged extra training and guidance for its A&E staff. The director of pathology at the hospital, Dr Jonathan Berg, who helped to carry out the study, says good technique is vital to ensure the tests reflect the true status of the patient.

"Junior doctors have surprisingly little training in taking blood and have a love of still using syringes which cause major problems and this is very easy to correct with a simple training programme. This is an issue right across the country".

The director of scientific affairs at the ACB, Dr Robert Hill, says there is a need for better training.

"The compromises to specimen quality made in A&E when attempting to rush through investigations clearly put some patients at risk, so fixing the problem requires more than just identifying a culprit.

"Solutions must include monitoring the competence of those taking blood during their training period and discouraging those whose lack of practice prevents them from doing it properly."

'Bread-and-butter' procedure

The study is being presented at the annual conference of the College of Emergency Medicine, which represents A&E doctors in the UK and the Republic of Ireland.

The college's president, Dr John Heyworth, says the paper is "universally relevant" to all A&E departments.

"It sounds a bread-and-butter procedure but it is very important that it is done correctly, safely and consistently. We need to ensure there is the right level of expertise.

"I think it is always seen as so routine, there is not enough focus on it as a technique for formal review and training."

The chairman of the BMA's Junior Doctor Committee, Dr Tom Dolphin, also welcomed the study.

"Emergency Departments are high pressure environments where junior doctors have to take blood in an efficient, timely manner.

"Bloods can be taken in a variety of ways and this study highlights some consequences of the choices faced by junior doctors when taking blood.

"Incorporating the findings of this research into training for junior doctors and medical students would be helpful if we are to reduce some of the issues that can arise from blood sampling."

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