QI in Action: Reducing Blood Specimen Rejections to Improve Patient Safety

Simple changes to labelling processes and teamwork helped St Vincent’s Hospital Melbourne reduce pre-transfusion specimen rejections in its Emergency Department, improving patient safety while saving nursing time and resources.

The ACHS Improvement Academy’s Quality Improvement Lead (QIL) Program supports healthcare professionals in implementing data-driven improvement initiatives within their organisations.      

In a busy Emergency Department, accurate blood specimen labelling is essential to safe and timely patient care. At St Vincent’s Hospital Melbourne, a quality improvement project led by Quality Improvement Partner Renae O’Toole set out to address a persistent problem with pre-transfusion specimen rejections, introducing practical changes to reduce errors and strengthen safety. 
 

Understanding the problem 

In October 2023, the Emergency Department’s average pre-transfusion specimen-rejection rate had exceeded 11% over the preceding two years, with monthly rates ranging from 7% to 15%. This was higher than comparable tertiary hospitals and other areas within the organisation. Further analysis found that most rejections were associated with the nursing team. 

The Emergency Department sees up to 160 patients daily, with more than 170 nurses and 80 doctors collecting over 200 group and hold samples each month. In this fast-paced environment, specimen errors can create additional workload, delay care and increase risks to patients. 

Incorrect blood identification can have serious consequences, including potentially fatal transfusion reactions caused by ABO incompatibility. Rejected specimens also raise concerns about wrong blood in tube errors, where a sample is labelled with another patient’s details. 

Working with representatives from the Emergency Department, Transfusion Committee and Quality and Safety team, Renae aimed to reduce pre-transfusion specimen rejections by 50% within 10 months. 
 

Practical changes to address the causes 

The team used data analysis, including a Pareto chart, to identify the main contributors to specimen rejection and understand where improvements could make the greatest difference. 

The first issue involved Bradma printers producing misaligned or poor-quality labels with missing characters. Replacing the printers and introducing larger labels offered a straightforward way to improve label legibility. 

Other common issues related to specimen labelling and request forms, with fatigue, time pressure, multitasking and human error identified as contributing factors. The team introduced a double-check process to help staff identify discrepancies before specimens were sent to pathology. 

The initiative, called ‘Grab a Mate – Say it Out Loud’, encouraged one staff member to read the patient identification label aloud while a colleague checked the details against the blood tube. Posters, laminated cards and reminders at points of care helped reinforce the practice across the department. 

New printers and labels were introduced in December 2023, supported by staff training and regular check-ins. The team also sent targeted feedback to staff involved in rejected specimens, helping raise awareness and reinforce safe practice. 

Recognising that sustained improvement required the involvement of the wider clinical team, the project later expanded to engage medical staff through departmental communications, intern orientation, safety emails and reminders near the pathology chute. Monthly safety briefings kept recent errors and improvement progress visible. 
 

Measurable improvements in safety and efficiency 

Although the project did not achieve its original target of a 50% reduction within 10 months, the rejection rate fell from 11% to 6.9% (a 37% improvement) and remained at that level monthly following the December 2023 interventions. 

The team also observed a sustained shift in the process, with more than eight consecutive data points below the control line indicating a meaningful improvement rather than random variation. 

The reduction represents $24 savings per collection in consumables and 7-10 minutes nursing time, while supporting safer and more efficient patient care. Fewer rejected specimens can help minimise repeat blood collection, reduce avoidable delays and support a better patient experience. 

 “As a consumer, it’s encouraging to see an issue analysed, simple solutions implemented and real, measurable improvements follow. Sometimes it’s just about the will to make positive change”. 

- David Jones, St Vincent’s Hospital Melbourne consumer 

Lessons for sustained improvement 

The project highlighted the importance of using reliable data to demonstrate the scale of a problem and track progress over time. Support from senior nursing staff helped build commitment, while early progress with the nursing team encouraged engagement from medical colleagues. 

The team also recognised that sustaining improvements in a busy Emergency Department requires ongoing communication and reinforcement. An increase in errors when graduate nurses started in February 2024 highlighted the need to embed safe practices into staff orientation and everyday routines. 

Regular updates through nursing and medical forums, alongside continued monitoring through the Emergency Department’s Knowing How We’re Doing huddle and Quality Committee, will help maintain momentum. 

The Transfusion Committee and Quality and Patient Safety team will also review broader organisational data to identify other high-risk areas where the lessons from this project can be applied. 
 

Explore projects from QIL Program Graduates         
You can read this full project on pg 9. in the QIL Project Summaries 2024 6th Edition.   

You can register for the next QIL intake or attend a free information session to see if the program is right for you. Connect with us for any other questions improvementacademy@achs.org.au.