Abstract

Blood investigations form an important aspect of patient management. Rationalisation of every test requested is needed to ensure optimum use of available resources. Wide variation in estimates of inappropriate laboratory use (4.5–95%) has been reported in literature. Hospitalisation beyond 7 days, complex cases, level of staff training, lack of awareness of costs are factors contributing to laboratory over utilisation.

We assessed our blood investigation ordering practices in order to evaluate unnecessary investigations and clinical variance. We aimed to develop a standard framework for ordering investigations in preterm babies.

This retrospective study (Jan-June 2010) evaluated blood investigations requested in first 14 days of life on the all the babies born <30 weeks gestation and admitted to our neonatal unit. These data amounted to ~5% of bed days on the unit over the study period. We created a standard investigation model for preterm babies and compared the findings with the standard.

37 babies were included in the study with total 479 cot days which represent 4.3% of unit cot days per year. We observed that we were requesting nearly 40% more tests as compared to standard. We estimated potential savings of £1000 GBP for only 4.3 % of total cot days every year in our unit.

Following audit was presented in our departmental meeting for the education of junior members of the staff and to raise the awareness of the costs of investigations and the need to reduce unnecessary testing. We recommended colour coding of pathology forms according to cost.