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To ABG or Not to ABG-Reducing Inappropriate Arterial Blood Gas Testing in Critical Care.

Juhi Rajan Patel1, Heather Jones1, Henry Houghton1

  • 1Department of Critical Care, Russell's Hall Hospital, the Dudley Group NHS Foundation Trust, Dudley, UK.

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Summary

An education and guideline intervention significantly reduced unnecessary arterial blood gas (ABG) testing in intensive care. This quality improvement initiative lowered costs, clinician time, and environmental impact without affecting patient safety.

Keywords:
arterial blood gascritical care nursingpatient safetyquality improvementsustainability

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Area of Science:

  • Critical care medicine
  • Quality improvement science
  • Healthcare sustainability

Background:

  • Arterial blood gas (ABG) testing is frequently overused in critical care settings.
  • Unnecessary ABG tests lead to increased healthcare costs, iatrogenic anemia, and wasted staff time.
  • There is also a significant environmental burden associated with resource consumption and waste from excessive ABG testing.

Purpose of the Study:

  • To assess the effectiveness of an educational and guideline-based intervention in reducing inappropriate ABG testing within a UK Intensive Care Unit (ICU).
  • To conduct a triple bottom line assessment, evaluating financial, operational, and environmental impacts.

Main Methods:

  • A pre- and post-intervention quality improvement project was conducted in a 23-bed level III ICU.
  • A local ABG guideline was implemented alongside bedside teaching and visual prompts.
  • The Sustainability in Quality Improvement (SusQI) framework guided the integration of sustainability principles.

Main Results:

  • Total ABG tests decreased by 34.4%, with a 22.9% reduction in inappropriate tests (NNT=4.4).
  • Significant savings were observed: £2781.90 in direct costs, 210.8 hours of clinician time, 1.396 L of blood, and 124.0 kg CO2e emissions.
  • No adverse effects on patient care were identified.

Conclusions:

  • A low-cost, nurse-led intervention effectively reduced unnecessary ABG testing, enhancing patient safety and delivering substantial financial, operational, and environmental benefits.
  • Integrating sustainability metrics into quality improvement strengthens the rationale for practice changes and supports the NHS Net Zero agenda.
  • Empowering critical care nurses with guidelines and education is key to improving ABG stewardship and promoting sustainable healthcare.