Coagulation Screening in Patients Admitted to the Acute Surgical Receiving Unit - Ninewells Hospital, Dundee, Scotland

Abstract

Introduction: Establish whether compliance to guidelines for routine pre-operative coagulation screening set by the National Institute for Health and Care Excellence (2016) is used on general surgical patients. Observe set components from guidelines with respect to the admission, dependent on grade of surgery and patient’s ASA grade. To determine financial loss per year from inappropriate/unnecessary coagulation testing performed on patients. Method: Review of all coagulation screening bloods taken for general surgical admissions to the acute surgical receiving ward over a 2 week period. The cost of one coagulation screen in NHS Tayside is £2.69. Clinical notes were reviewed in order to determine if criteria was met for performing a coagulation screening on admission. The results of the initial audit were presented at the Clinical Effectiveness meeting. The audit was repeated 2 weeks following a teaching session. Results: 200 individuals were included in the first cycle of the audit. It was found that 168 tests were ordered (161 unnecessary, 7 correctly screened, and 32 patients excluded appropriately). During the re-audit 208 patients were involved, and 153 tests were performed (151 unnecessary, 2 correctly screened, 55 patients excluded appropriately. Conclusion: As a result of the audit, coagulation screen sampling had decreased from 80.5% to 72.6%, an improvement of 7.9%. This equated to a savings of £26.90 over the duration of audit period (£699.20 per annum). This audit has demonstrated a change in clinical practice with potential significant financial benefit for the NHS.