Article Text

Download PDFPDF
Validation of phlebotomy performance metrics developed as part of a proficiency-based progression initiative to mitigate wrong blood in tube
  1. Noirin O’Herlihy1,
  2. Sarah Griffin3,
  3. Patrick Henn1,
  4. Robert Gaffney1,
  5. Mary Rose Cahill1,2,
  6. Anthony G Gallagher4
  1. 1 School of Medicine, University College Cork, Cork, Ireland
  2. 2 Haematology Department, Cork University Hospital Group, Cork, Ireland
  3. 3 Haematology, St. James’s Hospital, Dublin, Ireland
  4. 4 Faculty of Life and Health Sciences, University of Ulster - Magee Campus, Londonderry, UK
  1. Correspondence to N O’ Herlihy; 100312258{at}


Aims The purpose of this study was to (1) characterise the procedure of phlebotomy, deconstruct it into its constituent parts and develop a performance metric for the purpose of training healthcare professionals in a large teaching hospital and to (2) evaluate the construct validity of the phlebotomy metric and establish a proficiency benchmark.

Method By engaging with a multidisciplinary team with a wide range of experience of preanalytical errors in phlebotomy and observing video recordings of the procedure performed in the actual working environment, we defined a performance metric. This was brought to a modified Delphi meeting, where consensus was reached by an expert panel. To demonstrate construct validity, we used the metric to objectively assess the performance of novices and expert practitioners.

Results A phlebotomy metric consisting of 11 phases and 77 steps was developed. The mean inter-rater reliability was 0.91 (min 0.83, max 0.95). The expert group completed more steps of the procedure (72 vs 69), made fewer errors (19 vs 13, p=0.014) and fewer critical errors (1 Vs 4, p=0.002) than the novice group.

Conclusions The metrics demonstrated construct validity and the proficiency benchmark was established with a minimum observation of 69 steps, with no critical errors and no more than 13 errors in total.

  • Medical education & training
  • health services administration & management
  • quality in health care
  • haematology
  • blood bank & transfusion medicine

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors NOH collected data and drafted the manuscript. SG collected data and drafted the manuscript. PH collected data and revised the manuscript. RG collected data and revised the manuscript. MRC designed the study and revised the manuscript, AGG designed the study, performed statistical analysis and revised the manuscript. All authors read and approved the final manuscript.

  • Funding This work was supported by Cork University Hospital.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Clinical Research and Ethics Committee, University College Cork.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.