Bibliographic information Overall rating	Study* Category (points deducted)	Practice* Category (points deducted)	Outcome measures* Category (pts deducted)	Results/findings* Category (points deducted)
– Author(s): Sixsmith, DM; Weinbaum, F; Weinbaum F; Chan, SYA; Nussabaum M; Magdich, K.  – Year: 2000  – Publication: SAEM 2000 Annual Meeting Abstracts (abstract only)  –Affiliations: NY Hospital Medical Center of Queens, Flushing NY  – Funding: Internal	– Design: (0) 3-Period crossover trial. 2 week baseline (standard practice with regular vacuum tubes); 2 week practice trial with low vacuum tubes; 2 weeks back to standard practice – Facility/setting: (0) Hospital ED – Time period: (0) 3×2 week consecutive periods in 1999 – Population/sample: (1) All patients in ED getting blood chemistry tests: Total N=2743: Period 1) 1050; period 2) 725; period 3) 968. – Comparator: (0) 1) Regular vs. low vacuum tubes. Usual practice using regular vacuum tubes. No description of regular practice given beyond types of vacuum tubes used. No information or control for straight needle vs. IV starts or who drew sample. – Study bias: (0) None observed.	– Description: (0) Use of low vacuum tubes for blood chemistries. – Duration: (0) 6 weeks broken into 2 week segments: baseline with regular practice; test period with new practice; re-evaluation of baseline with regular practice – Training: (0) None – Staff/other resources: (0) Minimal – Cost: (0) Not provided.	– Description: (1) Hemolysis — no description of how it was measured. – Recording method: (0) No description.	– Type of findings: (0) Rates of hemolysis – Findings/effect size: (0) 1) Regular vs. low vacuum tubes. Baseline (regular vac.): 1: N=1050 Hemolysis rate=120/1050=11.4% Trial period (low vacuum): N=725 Hemolysis rate=19/725=2.6% Baseline 2 (regular vac.): N=968 Hemolysis rate=128/968=13.2% Overall ratio for regular vs. low vacuum is 4.36 (CI: 2.45–7.77) p<0.0001. – Statistical significance/test(s): (0) Fisher’s exact test — 2 tailed – Results/conclusion biases: (1) Evidence for a reduction in hemolysis based solely on type of vacuum tube used. Real world experience with comparison made on complete separation of practice, but with no controls for other practices.
Quality rating: 7 (fair)  Effect rating: SubstantialRelevance: Direct	Study (3 max): 2 Real world comparator is a pure practice (regular vacuum tubes), but uncontrolled for other practices (e.g. straight needle vs. IV start). Cross-over design minimizes any observation bias.	Practice (2 max): 2	Outcome (2 max): 1 No description of how hemolysis was measured or recorded.	Results/findings (3 max): 2 Real world results based solely on introduction of a new product — low (partial) vacuum tubes

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