Timing of blood draws among hospitalized patients: An evaluation of the electronic health records from a large health care system

Abstract

ABSTRACTImportanceEarly morning blood draws disrupt patients’ sleep and adversely affect patient experience.ObjectiveTo describe the trends in non-urgent early morning blood draws in a large health care system.DesignThis cross-sectional study analyzed trends in non-urgent early morning (04:00–06:59) blood draws using the electronic medical records of patients hospitalized between November 2016 and October 2019.SettingThe study was done at Yale New Haven Health System, which is Connecticut’s largest health care system consisting of 5 hospitals.ParticipantsWe included all blood draw events for hospitalized adult patients (≥18 years at the time of admission).Main outcome and measuresWe assessed the timing of non-urgent (excluding blood draws performed in the emergency department, critical care units, step-down units, and during the first 24 hours of admission) blood draws among hospitalized patients and determined if the trends of early morning (04:00–06:59) blood draws varied by patient characteristics or over the study duration.ResultsOf the 5,676,802 blood draw events included, 38.9% occurred between 04:00–06:59 with only modest differences across age, race and ethnicity, and gender subgroups. The proportion of early morning blood draws increased over the study period from 36.9% to 41.4% (P<0.001). Of the early morning samples, those collected between 04:00–04:59 decreased from 25.6% to 18.5%, those collected between 05:00–05:59 increased from 39.6% to 45.5%, and those collected between 06:00–06:59 increased from 34.6% to 36.0% (P<0.001, each).Conclusions and relevanceThe proportion of non-urgent early morning blood draws was persistently high over 3 years. There is a need to redesign hospital care to reduce sleep interruptions from non-urgent interventions.KEY POINTSQuestionWhat are the trends in non-urgent early morning (04:00–06:59) blood draws among non-critically ill hospitalized patients across a large health care system?FindingsThis cross-sectional study showed that 38.9% of all blood draws occurred between 04:00–06:59, with only modest differences across age, race and ethnicity, and gender subgroups. The proportion of early morning blood draws increased over the study period from 36.9% to 41.4% (P<0.001).MeaningThe proportion of non-urgent early morning blood draws remains persistently high, suggesting a need to redesign hospital care to reduce sleep interruptions from non-urgent interventions.