SP8.9 Pre-operative blood tests in abscess patients: Audit and cost analysis

Introduction

Abscess is one of the most common presentations in the emergency surgical setting. It is common practice in our unit to perform blood tests as part of the initial triage process by our nurses. However, NICE guidance (NG45) recommends that bloods should not be taken routinely for patients undergoing minor surgery (including abscess) who are ASA 1 or 2.

Aims

To determine the department’s compliance with NICE guidance, identify ways to improve compliance if required, Identify methods to improve patient experience e.g. waiting times and perform a cost analysis of unnecessary blood tests.

Methods

Retrospective analysis of 100 consecutive patients from June to September 2022, who had incision and drainage of abscess. The patients were selected from Surgical Emergency Unit admission book. Patient data including demographics, immunological compromise status, Morbidities such as diabetes, abscess site, anaesthetic type, blood tests performed and results, and admission and discharge times.

Results

56 females, 44 males. Majority fall in age group 25-59. 7 patients were ASA 3 or higher. 10 patients were diabetic.

93 patients had blood tests performed preoperatively. 16 patients had CRP >50, and 9 patients had WCC >15. Only 6 patients spent more than 1 day inpatient.

Cost of unnecessary blood tests in this group is 4,092£, cost over a year period is 24,552£.

Conclusion

There was poor compliance with NICE guidance costing the trust 24,552£ yearly. Blood tests did not change management plans or patients’ course. Better compliance can improve patient experience and save significant cost.