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[Reducing the number of orders for coagulation tests in the standard emergency department blood work-up]
José María Ferreras Amez1, Marco Antonio Sarrat Torres1, Belén Arribas Entrala2
1Servicio de Urgencias, Hospital Royo Villanova, Zaragoza. Grupo de Trombosis SEMES Aragón, España.
Insights
A new clinical protocol significantly reduced unnecessary coagulation test orders in the emergency department. This improved health service resource management without negatively impacting patient care.
Area of Science:
- Clinical Medicine
- Health Services Research
Background:
- Coagulation tests are frequently ordered in emergency departments.
- Over-ordering of diagnostic tests can lead to increased healthcare costs and unnecessary patient exposure.
Purpose of the Study:
- To assess the effectiveness of a clinical protocol designed to decrease the number of coagulation test orders.
- To evaluate the impact of the protocol on the utilization of health service resources.
Main Methods:
- A quasi-experimental study design with historical controls was employed.
- Retrospective analysis of patient records from the emergency department was conducted.
- The number of coagulation tests ordered during a standard practice period was compared to the period following protocol implementation.
Main Results:
- Coagulation test orders decreased from 77.2% during standard practice to 55.5% after protocol implementation (P <.001).
- Unnecessary test rates fell from 65.6% to 50.6% (P <.002).
- No significant adverse patient outcomes or changes in treatment plans were observed due to the reduction in testing.
Conclusions:
- The implemented clinical protocol effectively reduced the number of unnecessary coagulation tests.
- The protocol demonstrated success in improving the management of health service resources related to coagulation testing.
Objectives:
To evaluate the usefulness of a clinical protocol developed to reduce the number of orders for coagulation tests.
Material And Methods:
Quasi-experimental study with historical controls. We retrospectively included all patients whose records showed that a coagulation test had been ordered in the emergency department. We analyzed the number of tests ordered under the protocol and the number ordered during the period of standard practice.
Results:
Orders for coagulation tests were given for 657 patients (77.2%) when physicians followed standard practices and for 448 (55.5%) when they followed the protocol (P <.001). Unnecessary tests numbered 431 (65.6%) and 227 (50.6%) in the standard-practice and protocol periods, respectively (P <.002). One patient (0.15% [95% CI, 0.004%-0.8%]) had significantly altered coagulation (international normalized ratio, 1.8), but none (0% [95% CI, 0%-0.6%]) required treatment and no treatment plans were changed based on a finding of unexpected coagulation disorder.
Conclusion:
The protocol to guide the ordering of coagulation tests has managed to reduce unnecessary tests and thus improve management of this health service resource.
