Bibliographic information Overall rating	Study* Category (points deducted)	Practice* Category (points deducted)	Outcome measures* Category (pts deducted)	Results/findings* Category (points deducted)
– Author(s): Kathryn E. Hamilton; Cheryl Orr  – Year: 2011  – Publication: Unpublished  – Affiliations: Mary Washington Hospital, Fredericksburg, VA  – Funding: Internal	– Design: (0) Cross-Sectional Observational – Facility/setting: (0) 60-bed ED — very busy — draws conducted by first person to see patient: Nurse, paramedic, respiratory therapist or phlebotomist. – Time period: (0) Jan–July, 2011 – Population/sample: (0) All ED patients — all ages. – Comparator: (0) Nurse draw (usually IV start) — Note — nurse refers to all non-phlebotomist draws. – Study bias: (0) None observed — informant states that both nurse and phlebotomist have similar severity of patients.	– Description: (0) Phlebotomist draw (usually straight needle venipuncture at antecubital site) — located in ED, also has draw room for patients waiting to be triaged. – Duration: (0) Jan–July, 2011 – Training: (0) None – Staff/other resources: (0) None – Cost: (0) Minimal	– Description: (0) Automated colorimetric measures report hemolyzed samples. – Recording method: (0) Standard records.	– Type of findings: (0) Rates of Hemolysis – Findings/effect size: (0) IV start vs. straight needle Rate IV start (nurse); 216/6455=3.35% Rate venipuncture (Phleb.): 255/22,273=1.14% RR=3.35/1.14=2.76 – Statistical significance/test(s): (0) None conducted – Results/conclusion biases: (1) Results based on large numbers. Demonstrates a large RR for IV draws despite the relatively low rate of hemolysis among the nurses. While this study compares the two practices, they are conducted by differently trained people. This may modify the comparison to other studies.
Quality rating: 9 (good)  Effect rating:  Substantial  Relevance:  Direct	Study (3 max): 3	Practice (2 max): 2	Outcome (2 max): 2	Results/findings (3 max): 2 Conducted by differently trained staff.