Aims
Repetitive blood testing in hospital inpatients is widely recognised as a low value healthcare activity both nationally and internationally. We aimed to examine the frequency, clinical yield and cost of this practice by performing a retrospective audit of our medical oncology inpatient service.
Methods
A list of 70 consecutive patient encounters were extracted from our electronic medical records. Patients admitted to ICU at any point or with a length of stay ≤ 1 day were excluded. Basic demographic data including length of stay, cancer-specific details and principal admission diagnosis was collected. The number of individual blood panels (FBC, EUC, LFTs, CMP, CRP and coagulation) performed for each patient was recorded, the number that were clinically indicated and the number that showed clinically significant results. The costs for collection and testing were obtained from hospital administration to calculate a potential cost saving if testing was restricted to only when clinically indicated.
Results
A total of 54 patient encounters (covering the period from May- July 2018) met the inclusion criteria and were included in the analysis (median age 63 years; average length of stay 5 days; 93% metastatic disease; 80% receiving anti-cancer therapy). The average number of blood panels performed per patient was 18 (range 0-91) and 15 (83%) were not clinically indicated. Overall 93% of blood panel results (1155/1246) had no clinical significance. The potential cost saving if only clinically indicated blood tests were ordered was $7853 across this six week period equivalent to $68,059/ year based on conservative measurements.
Conclusion
Our unit recorded a high proportion of unnecessary repetitive blood tests. This represents an opportunity to reduce patient harm and potential significant cost saving. These results will be used to inform development of clinical guidelines for medical staff leading to more rational ordering of blood tests.