Reducing inappropriate blood testing in haematology inpatients: A multicentre quality improvement project

Abstract

Haematology inpatients are subject to extensive blood testing and many of these tests could be deemed inappropriate as they are not indicated for monitoring or clinical symptoms. Unnecessary testing exposes the patient to the risks of phlebotomy and adds resources' strain to the NHS.Our aim was to reduce the number of inappropriate blood tests performed on haematology inpatient wards.Quality improvement projects (QIPs) were performed in four haematology units introducing inpatient blood testing schedules (BTS) or providing staff education on current schedules.A reduction in inappropriate or overall blood testing was achieved at every site where a BTS was implemented, with a median reduction in inappropriate blood testing of 24.7% and estimated cost savings of up to £38,438 per annum.This QIP can be safely adapted to a variety of inpatient settings and is associated with cost savings. This initiative could be extended to other inpatient departments throughout the NHS.

Keywords: blood test; haematology; inpatient; phlebotomy; quality improvement.

Fig 1.

Percentage change in inappropriate blood test requesting by test type for plan, do, study, act cycles 1–3. a) St Bartholomew’s hospital. b) Royal Oldham Hospital. c) Bradford Royal Infirmary. Coag = coagulation; CRP = C-reactive protein; FBC = full blood count; LDH = lactate dehydrogenase; LFT = liver function tests; Mg = magnesium; U&E = urea and electrolytes.

Fig 2.

Change in the number of tests per inpatient days for plan, do, study, act cycles 1–3 at St James’s University Hospital. a) Non-allogeneic transplant schedules (‘intensive chemotherapy and autografts’ and ‘non-allogeneic transplant’). b) Allogeneic transplant schedules. Coag = coagulation; CRP = C-reactive protein; EBV/CMV = Epstein–Barr virus / cytomegalovirus; FBC = full blood count; LFT = liver function tests; Mg = magnesium; U&E = urea and electrolytes.

Fig 3.

Summary of the overall percentage inappropriate tests at St Bartholomew’s hospital, Royal Oldham Hospital and Bradford Royal Infirmary. Barts = St Bartholomew’s hospital; BRI = Bradford Royal Infirmary; ROH = Royal Oldham Hospital.

Fig 4.

Upper and lower savings per site, actual and potential (if no inappropriate tests were done). Barts = St Bartholomew’s hospital; ROH = Royal Oldham Hospital; SJUH = St James’s University Hospital.