If in doubt, put bloods out?

Reducing Unnecessary Blood Tests in Postoperative Elective Urology Patients

Introduction and Audit Rationale

Urology juniors at the Royal Devon and Exeter Hospital (RDE) have highlighted uncertainty about which bloods are required post op, with the handbook for juniors stating “if in doubt, put them [bloods] out”. Informal discussions with the juniors suggested that a lack of local or national standardised protocol for post op bloods was a contributing factor. To explore the impact of this, we audited the number of unnecessary bloods taken in post op urology patients at the RDE.

Local rationale: Reducing the number of unnecessary blood tests taken would reduce the burden on the junior team, prevent discharge delays and reduce risk of patient harm1,2. Additionally, all departments should aim to have a local protocol as per NHS England. 2 Wider rationale: Reducing the number of unnecessary blood tests taken and processed would save money, reduce environmental impact, prevent discharge delays and reduce risk of patient harm.1,2

Aims

This ongoing quality improvement project aims to reduce the number of unnecessary blood tests by 10 % by July 2023. Unnecessary bloods are defined as bloods that are not recommended by the devised local protocol or requested by the lead surgeon.

Methods

Using Epic to gather 4 weeks of retrospective data, information on all blood tests done day one post op in elective urology patients was collected and interpreted.

Audit standards were defined by a local protocol drawn up in collaboration with a urology consultant.

Blood tests were deemed unnecessary if they did not meet the local protocol and had not been specifically requested by the surgeon.

Audit Results

82 patients underwent an elective urological surgery within a four week time period, of these, 43 met the audit inclusion criteria

Key findings: In this 4 week time period, 100% of CRPs; 13.6% of FBCs; 9.1% of RFTs; 100% of LFTs done were unnecessary.

Over the four week period, there were 11 unnecessary blood tests that cost the laboratory £31.46.

Where an op note specified which bloods were required, there was a reduction in unnecessary blood tests.

Day One Local Protocol

PDSA Cycle 1

Local protocol of post-op bloods needed for each type of urological surgery was made into a poster and put up in the Urology juniors office to guide juniors.

Future Steps

Following the first implemented change, we will collect data to assess the impact of the poster on numbers of unnecessary blood tests. A second PDSA cycle will focus on trialling standardised instructions for post op bloods in the operation notes.