Routine coagulation testing in intensive care.
OBJECTIVE
To test a simple clinical guideline to reduce unnecessary routine testing of coagulation status.


METHODS
A prospective, unblinded, observational study of coagulation testing frequency before and after introduction of a simple clinical guideline. We included 253 patients admitted to a tertiary intensive care unit: 100 patients consecutively enrolled before our intervention (May - July 2015) and 153 patients consecutively enrolled after our intervention (August - September 2015).


METHODS
We introduced a clinical guideline and educational program in the ICU from 18 August 2015.


METHODS
The number of coagulation tests performed per patient bed-day, and the associated pathology costs.


RESULTS
Over the 3-month sample period, 999 coagulation profiles were performed for 253 patients: 720 (72%) in 100 patients before, and 279 (28%) in 153 patients after our intervention. The testing frequency fell from 1.12 to 0.41 per patient bed-day (P < 0.001). A total of 463 pre-intervention coagulation profiles (64%) were classified as unnecessary, and the cost of all coagulation tests fell by 60.5% per bedday after the intervention.


CONCLUSIONS
A simple clinical guideline and educational package reduced unnecessary coagulation tests and costs in a tertiary referral ICU.
Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia. steven.musca@gmail.com.
Steven
S
Musca
Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Shilpa
S
Desai
Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Brigit
B
Roberts
Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Timothy
T
Paterson
Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Matthew
M
Anstey
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D003422:Critical Care; D003479:Curriculum; D003955:Diagnostic Tests, Routine; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D058996:Quality Improvement; D012017:Referral and Consultation; D019564:Unnecessary Procedures