title: Blood tests: One too many? Evaluating blood requesting guidance developed for acute patients admitted to trauma and orthopaedic units.
abstract: In a recently published report from the Academy of Medical Royal Colleges, around 20% of clinical practice which encompasses blood science investigations is considered wasteful. Blood tests including liver function tests (LFTs), C-reactive protein (CRP), coagulation screens, and international normalising ratios (INR) are frequently requested for patients who undergo emergency hospital admission. The paucity of guidance available for blood requesting in acute trauma and orthopaedic admissions can lead to inappropriate requesting practices and over investigation. Acute admissions over a period of one month were audited retrospectively for the frequency and clinical indications of requests for LFTs, coagulation screens/INR, and CRP. The total number of blood tests requested for the duration of the patient's admission was recorded. Initial auditing of 216 admissions in January 2014 demonstrated a striking amount of over-investigation. Clinical guidelines were developed with multidisciplinary expert input and implemented within the department. Re-audit of 233 admissions was carried out in September 2014. Total no. of LFTs requested: January 895, September 336 (-62.5%); coagulation screens/INR requested: January 307, September 210 (-31.6%); CRPs requested: January 894, September 317 (-64.5%). No. of blood requests per patient: January (M=4.81, SD 4.75), September (M=3.60, SD=4.70). Approximate combined total cost of LFT, coagulation/INR, CRP in January £2674.14 and September £1236.19 (-£1437.95, -53.77%). A large decrease was observed in admission requesting and subsequent monitoring (p<0.01) following the implementation. This both significantly reduced cost and venepuncture rates.
authors.affiliation: Department of Trauma and Orthopaedics, NHS Tayside, Dundee, UK. Electronic address: a.faulkner1@nhs.net.
authors.forename: Alastair
authors.initials: A
authors.lastname: Faulkner
authors.affiliation: Department of Trauma and Orthopaedics, NHS Tayside, Dundee, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Reidy
authors.affiliation: Department of Trauma and Orthopaedics, Salford Royal Foundation Trust, Salford, UK.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Scicluna
authors.affiliation: Department of Trauma and Orthopaedics, NHS Tayside, Dundee, UK.
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Love
authors.affiliation: Department of Anaesthetics, NHS Tayside, Dundee, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Joss
mesh_terms: D000368:Aged; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006301:Health Services Needs and Demand; D006403:Hematologic Tests; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009985:Orthopedics; D010343:Patient Admission; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012606:Scotland; D019564:Unnecessary Procedures
keywords: Blood tests; Guidelines; Health economics