A closed-loop audit of routine pre-operative “Type and Screen” tests for laparoscopic cholecystectomy

Abstract

BackgroundHistorically, a ‘Type and Screen’ (T&S) comprises one of the routine blood tests performed pre-operatively for patients undergoing laparoscopic cholecystectomy (LC). Previous papers have shown low transfusion rates for cholecystectomy. We aim to confirm the lack of utility of routine T&S tests for laparoscopic cholecystectomy and investigate the impact of a change in practice using a closed-loop audit. MethodsStandards for the audit were derived from literature review. All patients who underwent laparoscopic cholecystectomy at Wexham and Heatherwood Hospitals in 2016 were included in the study. Retrospective data, including patient details, nature of procedure, timing and requirement for transfusion, was collected for all LCs over one year (n=493). Consequently, the pre-operative protocol was adjusted and the process re-audited. Results98% of patients undergoing LC had at least one blood sample taken for T&S tests pre-operatively. A total of 883 T&S samples were processed by the lab pertaining to laparoscopic cholecystectomy. Two patients required transfusion, both within 24 hours of surgery. A pre-operative T&S sample did not impact management in either case. There were no “high risk” cases identified in the pre-intervention or post-intervention cohorts.Modification of the pre-operative assessment protocol resulted in T&S samples being sent for 16% of patients. ConclusionsA pre-operative T&S did not impact management for any patient undergoing LC. As such, the T&S should not form part of the routine work up for standard LC, although it may still be required for high risk cases. This has led to a saving of £22,075 at our hospital.