title: Clinical need-directed blood tests: a step in saving the NHS?
abstract: BACKGROUND
  Unnecessary blood tests are estimated to contribute to 25% of wastage in the National Health Service. The aim of this study was to assess the financial implication of clinical need-focused blood tests guided by a senior clinician in a district general hospital.
  
  
  METHODS
  We conducted an observational longitudinal study over six months with pre- and postanalysis of a vetting intervention. A colorectal firm (Team A) implemented a vetting system that required a registrar or consultant to discuss which blood tests needed to be requested for each in-patient with junior doctors. Another colorectal firm (Team B) with a similar caseload was blinded to the study and was used as a control.
  
  
  RESULTS
  The vetting initiative demonstrated a reduction of 33% of blood test requests, translating to a cost-saving of £2406 over three months. Following the intervention, the median number of tests requested per patient per day by Team A for C-reactive protein reduced from 0.8 to 0.63 (P = 0.0074), full blood counts reduced from 0.8 to 0.67 (P = 0.0138), liver function tests decreased from 0.8 to 0.6 (P = 0.0021) and urea and electrolytes fell from 0.8 to 0.63 (P = 0.0083). The number of tests per patient per day after the intervention was significantly less than the control group (P < 0.001). The length of hospital stay and admission to critical care were not adversely affected in the group that had less blood tests, P = 0.808 and P = 0.58, respectively.
  
  
  CONCLUSIONS
  The direction, by a senior clinician, of the requesting of blood tests by junior doctors to ensure that requests were based on clinical need, reduced the number of inappropriate blood tests and resulted in some reduction in laboratory costs.
authors.affiliation: Department of General Surgery, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK zahir5019@gmail.com.
authors.forename: Zahir
authors.initials: Z
authors.lastname: Mughal
authors.affiliation: Department of General Surgery, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK.
authors.forename: Aravindan
authors.initials: A
authors.lastname: Narayanan
authors.affiliation: Department of General Surgery, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK.
authors.forename: Vivek
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of General Surgery, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Reay-Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001774:Blood Chemical Analysis / Q000191:economics*; D017046:Cost Savings; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D020380:Needs Assessment; D006113:United Kingdom
keywords: Laboratory demand management; blood tests; pathology requesting; vetting