765 Preoperative Coagulation Screening Audit in General Surgery

Abstract

Abstract Aim Routine preoperative coagulation screening is considered standard practice to predict peri-operative bleeding. However, according to British Society of Haematology, indiscriminate coagulation screening is not recommended as it may to inappropriate delay of surgery, lead to further unnecessary tests and is also associated with significant costs. Instead, they recommend detailed bleeding history, including family history and use of medications. This audit was to evaluate the current practice and improve. Method A retrospective audit of 148 post-operative patients, randomly selected in Northwick Park Hospital admitted under the General Surgery between 01.04.2021 to 14.05.2021 at the initial audit and between 20.09.2021 to 07.10.2021 at the re-audit. Results The initial audit was done over a 6-week period with 98 cases selected. 19% of them had appropriate requests with 81% of the tests done being inappropriate. There was significant improvement by the re-audit with appropriate requests increasing to 56% and inappropriate tests dropping at 44%. The criteria for appropriate were a) Not requested as no significant medical history. b) Requested as clinically indicated. With each coagulation screening costing an average of £29.42, an overall estimate of £2971.42 was expended in inappropriate requests Conclusion All patients had relevant blood requests and PMH were documented but many inappropriate requests were made. It was recommended that instead of indiscriminate coagulation testing, a thorough history was advised to determine appropriate testing. There was a marked improvement at the re-audit with more appropriate requests being made. Recommendations Further meetings with the Anaesthesiologists to ensure a joint effort in achieving the target goal