Hemolysis Index-based Estimated Redraw Risk and Cost Impact across Clinical Settings

This study evaluated the hemolysis index (HI) distribution, estimated the redraw risk and associated cost across clinical settings using the publicly available de-identified ADLM/AACC 2023 Help with Hemolysis Data Challenge dataset. Of the 101,174 test results, 101,039 valid results from 42,877 unique specimens were analyzed. A specimen was classified as meeting the estimated redraw-risk definition when at least one orderable result had an HI greater than or equal to its orderable-specific redraw threshold. The setting-specific unit cost was applied once per risk specimen. Overall, 859 specimens (2.0%) met the estimated redraw-risk definition. The proportion of specimens meeting the estimated redraw-risk definition was highest in the emergency setting (3.5%), followed by the outpatient (2.6%), inpatient (1.8%), and intensive care settings (1.6%). Compared with inpatient specimens, emergency specimens had higher adjusted odds of meeting the estimated redraw-risk definition after adjustment for age and sex and accounting for within-patient correlation due to repeated specimens using generalized estimating equations (adjusted odds ratio, 1.81; 95% confidence interval, 1.49~2.19). The total estimated redraw-related cost was USD 316,155.39. Inpatient care contributed the highest total cost, whereas emergency care had the highest cost per 1,000 specimens. Among specimens meeting the estimated redraw-risk definition, 156 (18.2%) had two or more threshold-exceeding orderable results. These findings support specimen estimation and targeted preanalytical quality management in higher-risk clinical settings.