Intended for healthcare professionals

Rapid response to:

Observations

Should we abandon routine blood tests?

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2091 (Published 03 May 2017) Cite this as: BMJ 2017;357:j2091

Rapid Response:

Routine blood tests: assessing and changing post-operative practice

We read with interest the article by Faulker et al as well as the responses on BMJ.com on abandoning routine blood tests. It is apparent that the view on this topic varies from specialty to specialty. Ultimately, we feel that it is the responsibility of individual departments to assess the local incidence of routine blood tests and their implications. In an elective surgical specialty with a high turnover such as Urology, there are no official guidelines on which patients should have post-operative blood tests. A 3-month audit of all patients undergoing Grade 1-3 urological procedures in a district general hospital revealed that 55% of patients underwent post-operative blood tests including LFTs and clotting screens. No patient received an unplanned blood transfusion or suffered from TUR syndrome. The total annual cost of performing these tests was £3416.08 and >90% of results were reported after 11am thus delaying patient discharge (1). When reasons for this were explored, it became apparent that often the junior team were unsure as to whether blood tests were required and would request them "just in case". Following issuance of clear local guidelines emphasised in departmental induction, re-audit revealed a 75% reduction in the incidence of these tests (unpublished data). Operating surgeons adopted a patient-specific approach based on intra-operative judgement and clinical assessment as to whether a patient would need post-operative tests. This amounted to significant savings for the Trust both in terms of laboratory requirements and patient flow whilst maintaining safe practice. It is therefore apparent that an individualised approach is key to assessing and changing practice within different departments particularly in the current NHS climate of limited resources.

References:
1. Post-operative blood tests in patients undergoing urological surgery. Ravindra P, Lam G and Miller MAW. Journal of Clinical Urology 2016, Vol. 9(1S) 9–77

Competing interests: No competing interests

15 May 2017
Pravisha Ravindra
ST6 Urology
George Lam F2, Marek Miller Consultant Urologist
Northampton General Hospital