Journal of Hospital & Medical Management

Introduction

Coagulation profiles are ordered for a variety of conditions in ED. Cost-effectiveness and efficiency are of increasing relevance in hospital medicine. Ordering unnecessary coagulation studies is of concern in a Model 3 hospital due to ineffective utilization of resources with limited laboratory staffing. Adherence to practical guidelines should help effect clinical decision making, resource utilization and cost savings [1].

Aim

To determine volume and appropriateness of coagulation tests ordered from ED

Methods

Chart review of attendances between 2nd-8th March 2020 where coagulation studies requested. Appropriateness was determined by reference to clinical guidelines developed by consultants in the department [2].

Results

Age distribution of parents with coagulation studies (Figure 1).

Figure 1: Age distribution of parents with coagulation studies.

Flow chart of patients presented in a week (Figure 2).

Figure 2: Flow chart of patients presented in a week.

Comparison of patients adhering to criteria for coagulation tests (Figure 3).

Figure 3: Comparison of patients adhering to criteria for coagulation tests.

Discussion

We found that there was no suitable indication for 68.6% of tests indicating significant wastage. The local cost for SINGLE coagulation test is 2.87 Euros [3]. Implementation of clinical guidelines, educational packages and/or algorithms in ED for nurses and physicians should reduce unnecessary coagulation testing [4]. This will enable effective utilization of laboratory resources as well as reduce financial cost. We desire at least 80% coagulation tests sent to be appropriate in Wexford ED thus further education and intervention is required [5].

Limitations

Limitations of the study includes missing charts; possibly being utilized for other audits or presentations; charts removed from ED for early pregnancy unit; misfiling or other reasons. This warrants further review and electronic scanning and warehousing of charts should be considered to avoid potential medico-legal consequences.

References

1. Gupta R, Mondoux S, Rutledge G (2020) Reducing utilization of unnecessary coagulation tests by emergency providers. Can J Emerg Med 22: 55-56.
2. Goldberg N, Chaudhry H, Ackery A, Sholzberg M (2017) Reduced Reducing Unnecessary Coagulation Testing in the Emergency Department. BMJ Qual Improv Rep 130: 55-81.
3. Murphy E, Mac S, McGroarty C (2015) A novel approach to improving coagulation sample ordering in an emergency department. BMJ Qual Improv Rep 4: 22-25.
4. Fralick M, Hicks LK, Chaudhry H (2017) Reducing Unnecessary Coagulation Testing in the Emergency Department. BMJ Open Quality 6: 161-165
5. Boran G, Gaffney P, Condell S (2014) Sensible Test Ordering Practice in an Emergency Department Tallaght Hospital Dublin.