Bibliographic information Overall rating	Study* Category (points deducted)	Practice* Category (points deducted)	Outcome measures* Category (pts deducted)	Results/findings* Category (points deducted)
– Author(s): Marcus EH Ong; Yiong Huak Chan; Chin Siah Lim.  – Year: 2008  – Publication: Ann Acad Med Singapore  – Affiliations: Singapore General Hospital, Singapore  – Funding: Internal  – Author(s): Marcus EH Ong; Yiong Huak Chan; Chin Siah Lim.  – Year: 2009  – Publication: Am J Med  – Affiliations: Singapore General Hospital, Singapore  – Funding: Internal	– Design: (0) Cross-Sectional with follow-up – Facility/setting: (0) No description. Estimated an average of 200 UE samples collected daily – Time period: (1) Not described. – Population/sample: (0) Convenience population of 227 patients. All patients requiring blood urea and electrolytes (UE) during study time period were eligible. No requirements put upon personnel drawing blood – Comparator: (0) 1) Straight needle vs. IV start 2)Syringe vs. vacuum tube 3) =21 vs. >21 gauge needle Other comparisons not being evaluated: operator, blood flow, difficulty of draw, source (venous vs. arterial) – Study bias: (1) None observed — only used UE samples. Did not control for other parameters (but did state no statistical influence by operator).	-Description: (1) Scanty protocol provided. No description of patients selection (N seemed small) or time period. No controls put on methods or participation of operators. Follow-up study evaluated change in numerous practices parameters and overall hemolysis rates, but did not provide rates by practice parameters. – Duration: (0) Not specified. – Training: (0) None in Phase 1 — Education in phase 2. – Staff/other resources: (0) Minimal – Cost: (0) Not specified.	– Description: (0) Hemolysis defined using standard laboratory procedure — not defined. – Recording method: (0) Questionnaire on blood draw parameters with patient label matched to reported laboratory outcomes (hemolysis	– Type of findings: (0) Rates of hemolysis – Findings/effect size: (0) Phase 1: N=227. Straight needle vs. IV start: 4 (6.8%) vs. 41 (24.4%) OR=4.4 (1.5–13.0) Syringe vs. Vacuum tube: Insufficient control ≤21 gauge needle vs. >21 gauge: Insufficient control Logistic regression analysis has inadequate data to provide much information. Phase 2: N=204 Significant changes in practices including straight needle vs. IV starts and syringe vs. vacuum tube resulted in reduction of hemolysis rates for 19.8% before to 4.9% after. However, no rates by practice provided – Statistical significance/test(s): (0) ORs and CIs provided. – Results/conclusion biases: (1) Convenience sample with little description and no data provided to control for other practice parameters.
Quality rating: 6 (fair)  Effect rating: SubstantialRelevance: Direct	Study (3 max): 1 No description of study time period, hospital, etc. Lack of cross-parameter analyses.	Practice (2 max): 1 Very minimal description of study	Outcome (2 max): 2	Results/findings (3 max): 2 Lack of control for other practice parameters and sample size does not support logistic regression

^*Numbers in () by category headings reflect the number of points deducted from the maximum points for that column domain.