Bibliographic information Overall rating	Study* Category (points deducted)	Practice* Category (points deducted)	Outcome measures* Category (pts deducted)	Results/findings* Category (points deducted)
– Author(s): Shannon M. Straszewski; Leon Sanchez; Daniel McGillicuddy; Kirsten Boyd; Jane DuFresne; Nina Joyce; Richard Wolfe; Alice W. Lee; Jonathan Fisher; John L. Mottley  – Year: 2011  – Publication: Intern Emerg Med  – Affiliations: Beth Israel Deaconess Medical Center, Boston, MA  – Funding: Internal	– Design: (0) Before/after experiment mandating use of separate straight needle venipuncture for lab studies – Facility/setting: (0) Level 1 trauma center with ED volume of 55,000/year. – Time period: (0) 5-week time period: 1 week baseline and 4-week test period. – Population/sample: (1) Adult ED patients — provided only number of blood samples — not specified if there could be more than one sample per patient. N samples=2879 (315 baseline, 2564 trial) – Comparator: (0) Straight needle vs. IV start Baseline involved mixed use of separate straight needle venipuncture (21 gauge butterfly with vacuum tube) and IV starts (mixed gauge with vacuum tubes) for lab potassium studies. – Study bias: (1) None observed. Difficult to calculate ORs given no indication of % needle vs. IV distribution at baseline. Also confounded by some minimal training and impact of being observed/forced change of practice.	– Description: (0) Intervention: all lab draws conducted with straight needle (21g butterfly) and vacuum tube. Some education on how to minimize hemolysis. – Duration: (0) 5-week time period: 1 week baseline and 4-week test period. – Training: (0) Some on reducing hemolysis. – Staff/other resources: (0) Draws conducted by normal staff — ED nurses and technicians — modest amount of training on how to minimize hemolysis. – Cost: (0) Not provided	– Description: (0) Hemolysis determined by visual inspection and reported as none, moderate and gross. Critical hemolyzed sample was defined as having potassium levels >5.1 mEq/L (outside normal range),) which requires re– sampling. – Recording method: (0) Study relied only on hemolysis data reported by laboratory — change in practice was universal and compliance was not reported (assumed 100%).	– Type of findings: (0) Rates of hemolysis – Findings/effect size: (0) N total=2879. Baseline week N=315 4-Week trial N=2564 (641/week) Straight needle vs. IV start Baseline rate: Hemolyzed– 23% (CI: 16.7329.1) Critical=6,7% Trial rate (100% straight needle): Hemolyzed=6.6% (CI: 5.537.5) Critical=2.0% – Statistical significance/test(s): (0) p<0.0001 (method not specified) – Results/conclusion biases: (1) Unit of measure is the potassium lab sample (thus one per patient except for redraws). However, no explanation is given for why volume during the test period was double that of the baseline period. No attempt to evaluate percent straight needle v IV start draws during baseline. Short term study could be impacted by “observation effect. Study does highlight real life changes.
Quality rating: 7 (fair)  Effect rating: SubstantialRelevance: Direct	Study (3 max): 1 Comparator is a mixed practice. Unexplained disparity between baseline and trial volume of tests	Practice (2 max): 2	Outcome (2 max): 2	Results/findings (3 max): 2 Discordant patient volume between baseline and trial. Training adds confounding

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