Validation of phlebotomy performance metrics developed as part of a proficiency-based progression initiative to mitigate wrong blood in tube

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, 2) evaluate the construct validity of the phlebotomy metric and establish a proficiency benchmark. Method: Using video recordings of the procedure, 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 69% fewer errors (19 vs 13, p = 0.014) and 300% 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.