# Audit of Group and Save Sample Rejection in Fractured Neck of Femur Patients at a United Kingdom District Hospital

## TL;DR

This audit found that nearly 40% of blood samples for surgery were rejected due to labeling and documentation errors, but implementing new protocols cut rejection rates in half.

## Contribution

The study introduces standardized protocols for sample collection that significantly reduce rejection rates in a UK district hospital setting.

## Key findings

- 37.4% of Group and Save samples were initially rejected, primarily due to labeling and documentation errors.
- Implementing interventions like standardized labeling and electronic validation reduced rejection rates to 16.6%.
- Each rejected sample cost between £12 and £80, highlighting financial benefits from reducing errors.

## Abstract

Background: Accurate preoperative blood grouping and antibody screening are critical for trauma and orthopaedic (T&O) surgery. Group and Save (G&S) samples are frequently rejected due to labelling discrepancies, incomplete documentation, or sample quality issues. Such rejections delay surgery, increase patient discomfort from repeated venepuncture, and generate avoidable financial and operational burdens. This audit assessed the frequency, underlying causes, and financial implications of rejected GS samples for T&O patients in the Accident and Emergency (A&E) department and developed targeted recommendations to minimise error rates.

Methods: A retrospective clinical audit was conducted at the Luton and Dunstable Hospital NHS Foundation Trust, United Kingdom, encompassing all patients admitted with neck of femur (NOF) fractures between September 2024 and March 2025. Laboratory information system data and request forms were reviewed to identify rejected samples, categorise causes of rejection, and determine the staff group responsible for collection. Cost estimates were calculated using the hospital's local pathology finance reports. A follow-up re-audit was conducted after implementing the initial audit's recommendations, from July to October 2025.

Results: Of 171 G&S samples, 64 (37.4%) were rejected. The majority (62.5%, n=40) were taken by A&E staff. Predominant causes were absent signatures, missing date/time, mismatched identifiers, and sample integrity issues (haemolysis/underfilling). Approximately 20% (n=13) of affected patients required ≥2 repeat samples. The direct cost per rejected sample ranged from £12 to £80. After interventions, a re-audit of 84 samples showed the rejection rate fell to 16.6% (n=14).

Conclusions: Sample rejection in A&E is a preventable source of perioperative inefficiency. Most errors stemmed from documentation/labelling lapses. Implementing standardised bedside labelling, electronic order validation, and mandatory competency refreshers supported by a G&S checklist substantially reduced rejection rates. These measures optimise workflow, reduce costs, and enhance patient safety.