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Bridging the GAP: efficient usage of pathology services in paediatrics and neonatal medicine
  1. V Venkatesh,
  2. SN Mitra,
  3. D Williams
  1. Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Abstract

Background In 2005, around 175 million samples were sent for analysis to NHS pathology laboratories in England. Pathology departments in England had a combined gross budget of £1.8 billion in 2005/2006, and on average each Trust spent 5.1% of its total budget on pathology. Audits conducted in a different speciality showed 33% inefficient usage of pathology services.

Aim To improve efficiency in the use of pathology services in Paediatrics and Neonatal Medicine.

Methods A small project team of senior paediatric specialist registrars (ST6 and above) was formed. We compared two 5 month blocks for pathology tests usage (Retrospective (Jan 2010 - May 2010) and prospective (Jan 2011-May 2011)). Series of measures were undertaken to improve awareness in order to efficiently order pathology requests. These included increased awareness at handover, academic meetings, on the wards, email reports of the number and pattern of tests ordered, use of posters on the wards, increased usage of near patient testing, designing specific pathways for specific disorders and developing guidelines after service evaluation and audits and ongoing review of the project by the project team. In addition, we compared activity in terms of number of admissions and length of stay.

Results A 25 % reduction in the number of tests was seen (58,589 (Jan-May 2010) v/s 43,955 (Jan –May 2011) between the two time periods. The most commonly ordered tests included Full Blood Count (12% in both time periods), C reactive Protein (7.2% (Jan-May 2010) v/s 6.5% (Jan - May 2011) Urea and Electrolytes (5% in both time periods). During the 2 time periods Jan 2010-May 2010 v/s Jan 2011- May 2011 activity reported month on month was comparable in terms of number of admissions (3400 v/s3586) and length of stay (elective: 2.6 v/s1.7 (median) non elective: 3.65 v/s 3.725 (median)).

Conclusion A combined method of improving awareness, developing new guidelines and pathways can contribute to a reduction in the usage of pathology services.

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