Indiscriminate Coagulation Screening of Acute Medical Admissions: National Cost Ramifications

• Published in: Scottish medical journal 2009-11, Vol.54 (4), p.32-34
• Main Authors: Hughes, MA, Duckworth, AD, Edmond, I, Tan, LL, Ripley, DP, Tucker, J, Leslie, PJ
• Format: Article
• Language: English
• Subjects: Acute Disease; Blood Coagulation Tests - economics; Diagnostic Tests, Routine - economics; Diagnostic Tests, Routine - standards; Humans; Management Audit; Practice Guidelines as Topic; Prospective Studies; Scotland
• ISSN: 0036-9330; 2045-6441
• DOI: 10.1258/rsmsmj.54.4.32

Background Routine coagulation screening constitutes poor medical practice and is wasteful of resources. We aimed to determine the extent of inappropriate coagulopathy screening of acute medical admissions in a Scottish general hospital. Methods One hundred consecutive medical admissions were prospectively analysed, assessing whether or not a coagulation screen had been conducted on admission and whether or not this was indicated according to current hospital guidelines. Following targeted dissemination of guidelines to appropriate front door medical and nursing staff the audit was repeated. Results Pre-education, 58% of those for whom coagulation screening was not indicated were being tested. After targeted education, this figure was reduced to 32%. Preeducation, 81% of all patients in whom coagulation screening was indicated were tested. After targeted education, this figure was 86%. Conclusion Indiscriminate coagulation screening is widespread amongst medical admissions to our unit. With simple targeted education, we reduced the rate of inappropriate testing by 26% without reducing the rate of appropriate testing. In a small district general hospital (where the mean local cost for processing a haematology specimen is £8.59) this translates into a saving of £21,000 per annum. Extrapolated nationwide this represents a cost saving of £1.15 million per annum in Scotland.