EP 291 All Bleeding Stops Eventually: Reducing Unnecessary Blood Tests in an Acute General Surgery Clinic

Introduction

Ambulatory Surgical Centres (ASC) provide patients with acute presentations rapid access to senior surgical decision-making. Routine coagulation testing is commonly performed at presentation as part of standard “surgical assessment bloods”, despite limited clinical utility in many ambulatory patients. This is driven by concerns that deferring laboratory tests until after clinical review may delay patient flow, but causes unnecessary laboratory processing, consumable use, and staff workload. Reducing low-value investigations is increasingly important for environmentally and financially sustainable healthcare.

Aim

To evaluate the clinical utility and costs of routine coagulation screening in ASC, and the impact of replacing this with targeted INR Point-of-Care Testing (POCT) following clinical review.

Methods and Results

An audit of general surgery patients presenting to the ASC over a six-day period was conducted. Electronic patient records were reviewed for blood test utilisation, coagulation results, relevant clinical history, and whether abnormal results influenced management.

185 patient records were reviewed. Blood tests were performed in 121 patients (65%), including 100 coagulation screens. 14 coagulation results were abnormal; however, none influenced clinical decision-making. A targeted POCT-supported approach would have reduced coagulation testing from 100 to 2 tests during the audit period. This equates to over 4,100 fewer tests annually, with an estimated reduction of 272 kg CO₂e. After accounting for POCT equipment costs, projected financial savings exceed £33,000 per year over the first five years.

Conclusions

Targeted POCT INR represents a simple, scalable innovation that supports sustainable ambulatory surgical pathways and has potential for wider adoption across high-throughput services.