290 ‘Save Blood' - Strategies to Reduce Inappropriate Routine Bloods Tests in a Surgical Department

Abstract

Abstract Aim To quantify the number of inappropriate blood tests in our 72-bed Surgical Department and identify strategies that reduce the number of unnecessary electronic blood test requests. This should reduce patient harm, demands on staff time, laboratory processing burden and financial expenditure. Method Each audit involved logging all blood tests for every surgical inpatient over two consecutive days. Upon reviewing the clinical records, it was decided whether tests were clinically indicated or ‘inappropriate’. Following a baseline audit, three interventions were sequentially introduced over a one-year period, and the department re-audited after each: (1) educational sessions with junior medical staff and creation of ordering guidelines, (2) poster presentations, and (3) policing of requests by middle-grade doctors and removal of electronic blood test ordering bundles. Results Across the baseline audit to interventions 1–3, numbers of patients with at least one inappropriate test were recorded as 45/73 (62%), 51/63 (81%), 41/57 (72%), and 27/32 (84%), accruing totals of 363, 289, 303, and 149 inappropriate tests respectively. This gave an overall reduction in the rate of inappropriate blood tests per patient per day from a baseline of 0.9, to 0.9 then 0.8 to 0.5 with successive interventions. Conclusions Despite the innovation of electronic ordering systems enabling close audit of test schedules, inappropriate tests remain common. Educational sessions for junior doctors, written guidelines, and poster presentations had little influence on this. However, rationalising electronic order bundles and involving senior doctors in decision-making, almost halved the rate of inappropriate tests. These more effective strategies will be disseminated throughout our hospital.