Clinical need-directed blood tests: a step in saving the NHS?
Zahir Mughal1, Aravindan Narayanan2, Vivek Gupta2
1Department of General Surgery, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK zahir5019@gmail.com.
Insights
Implementing clinical need-focused blood tests reduced unnecessary requests by 33%, saving £2406 in three months. This approach did not adversely affect patient outcomes or hospital stays.
Area of Science:
- Healthcare Management
- Clinical Pathology
- Health Economics
Background:
- Unnecessary blood tests contribute significantly to healthcare waste.
- Estimates suggest 25% of National Health Service wastage stems from superfluous laboratory investigations.
Purpose of the Study:
- To evaluate the financial impact of clinical need-based blood test ordering.
- To assess the effectiveness of senior clinician guidance in reducing unnecessary blood tests in a hospital setting.
Main Methods:
- An observational longitudinal study was conducted over six months.
- A vetting intervention was implemented in one colorectal firm (Team A), requiring senior clinician discussion for blood test requests.
- A control colorectal firm (Team B) was used for comparison.
Main Results:
- The vetting intervention led to a 33% reduction in blood test requests.
- This resulted in a cost saving of £2406 over three months.
- Significant reductions were observed in daily requests for C-reactive protein, full blood counts, liver function tests, and urea and electrolytes.
Conclusions:
- Directing blood test requests by junior doctors based on clinical need, under senior clinician guidance, reduces inappropriate testing.
- This strategy leads to a reduction in laboratory costs without negatively impacting patient care or hospital stay duration.
Background:
Unnecessary blood tests are estimated to contribute to 25% of wastage in the National Health Service. The aim of this study was to assess the financial implication of clinical need-focused blood tests guided by a senior clinician in a district general hospital.
Methods:
We conducted an observational longitudinal study over six months with pre- and postanalysis of a vetting intervention. A colorectal firm (Team A) implemented a vetting system that required a registrar or consultant to discuss which blood tests needed to be requested for each in-patient with junior doctors. Another colorectal firm (Team B) with a similar caseload was blinded to the study and was used as a control.
Results:
The vetting initiative demonstrated a reduction of 33% of blood test requests, translating to a cost-saving of £2406 over three months. Following the intervention, the median number of tests requested per patient per day by Team A for C-reactive protein reduced from 0.8 to 0.63 (P = 0.0074), full blood counts reduced from 0.8 to 0.67 (P = 0.0138), liver function tests decreased from 0.8 to 0.6 (P = 0.0021) and urea and electrolytes fell from 0.8 to 0.63 (P = 0.0083). The number of tests per patient per day after the intervention was significantly less than the control group (P < 0.001). The length of hospital stay and admission to critical care were not adversely affected in the group that had less blood tests, P = 0.808 and P = 0.58, respectively.
Conclusion:
The direction, by a senior clinician, of the requesting of blood tests by junior doctors to ensure that requests were based on clinical need, reduced the number of inappropriate blood tests and resulted in some reduction in laboratory costs.
Related Concept Videos
01:26Therapeutic Drug Monitoring: Drug Analysis Methods
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:16Therapeutic Drug Monitoring: Overview and Classification
01:30Serum Laboratory Studies, Stool Test, Breath Test
01:26Blood Studies I: ABG and VBG
Arterial Blood Gas (ABG)
Arterial Blood Gas (ABG) studies are crucial for assessing the lungs' ability to supply oxygen and remove carbon dioxide, reflecting the patient's ventilation status. They also help understand the kidneys' capacity to...