G238(P) Tap it: trainee led initiative to reduce unnecessary blood testing in the emergency department

Aims Unnecessary blood testing in the paediatric emergency department (PED) is a potential starting point for diagnostic dilemma, anxiety to families and increased healthcare costs. We hypothesized that a significant number of blood tests are performed instinctively rather than clinically indicated. This stimulated a quality improvement initiative to enlighten trainees on the utility of blood tests while aiming to enhance clinical decision making. Methods Children presenting to the acute care team in a tertiary PED who had blood tests over a 2-week period in April 2019 were enrolled. Blood tests requested were interpreted in line with presenting features and clinical impression. Sequel to the evaluation, anonymised case vignettes were circulated to trainees and advanced nurse practitioners (ANPs) to ascertain their practice of blood tests requests. Recurrent audit cycles have been ongoing for sustainability of scientific logic based practice. Results One hundred and one children who had blood tests were enrolled. All the children had full blood count test done; 93%, 70%, 47%, 44% and 32% had renal function, liver bloods, bone profile, blood culture and clotting testing done respectively. Over half of these blood tests had no clear clinical indication. The yield of the tests performed without clinical indication was 0%. Case vignettes were attempted by 26 trainees and ANPs to evaluate their attitudes to blood test requests. Number of requested blood tests not clinically indicated was lower than anticipated; probably explained by self-thought processes. Repeat cycles have shown over 80% reduction in number of liver blood tests performed in jaundiced infants. Conclusions The utility of blood tests may be an easily forgotten subject in paediatric training. It is noteworthy that implementation of measures to reduce unnecessary blood test requests will result in an estimated savings of £1000/month. Interventions comprising regular educational sessions, audits, posters and blood tests champions are in place to sustain the reduction of unnecessary blood tests.