Blood tests: One too many? Evaluating blood requesting guidance developed for acute @entity1 admitted to XXXX and orthopaedic units.

@entity1 @entity130 @entity1851
In a recently published report from the Academy of Medical Royal Colleges, around 20% of clinical practice which encompasses blood science investigations is considered wasteful. Blood tests including liver function tests (LFTs), @entity1851 ( @entity1851 ), coagulation screens, and international normalising ratios (INR) are frequently requested for @entity1 who undergo emergency hospital admission. The paucity of guidance available for blood requesting in acute @entity130 and orthopaedic admissions can lead to inappropriate requesting practices and over investigation. Acute admissions over a period of one month were audited retrospectively for the frequency and clinical indications of requests for LFTs, coagulation screens/INR, and @entity1851 . The total number of blood tests requested for the duration of the @entity1 's admission was recorded. Initial auditing of 216 admissions in January 2014 demonstrated a striking amount of over-investigation. Clinical guidelines were developed with multidisciplinary expert input and implemented within the department. Re-audit of 233 admissions was carried out in September 2014. Total no. of LFTs requested: January 895, September 336 (-62.5%); coagulation screens/INR requested: January 307, September 210 (-31.6%); CRPs requested: January 894, September 317 (-64.5%). No. of blood requests per @entity1 : January (M=4.81, SD 4.75), September (M=3.60, SD=4.70). Approximate combined total cost of LFT, coagulation/INR, @entity1851 in January   2674.14 and September   1236.19 (-  1437.95, -53.77%). A large decrease was observed in admission requesting and subsequent monitoring (p<0.01) following the implementation. This both significantly reduced cost and venepuncture rates.
