ArticleBMJ open quality2023
Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients.
Article in BMJ open quality, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
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Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Decarbonizing surgical care: a qualitative systematic review guided by the Congruence Model.BMC health services research · 2024Pooled it
- Strategies and tactics to reduce the impact of healthcare on climate change: systematic review.BMJ (Clinical research ed.) · 2024Pooled it
- De-implementation of routine laboratory testing in a surgical intensive care unit: lessons from a two-phase quality improvement initiative.BMJ open quality · 2026Article
- From patient to planet: integrating climate impact into a hospital medicine initiative reducing blood urea nitrogen testing.BMJ open quality · 2026Article
- Integrating environmental considerations in HTA: The strategy of the Institut National d'Excellence en Santé et Services Sociaux (INESSS).International journal of technology assessment in health care · 2026Article
- The environmental impacts of surgical care pathways: same-day-discharge versus enhanced recovery following minimally invasive colectomy and stoma reversal.Surgical endoscopy · 2026Article
- Adherence to Diagnostic Imaging Pathways for Patients Presenting to Emergency Departments With Undifferentiated Acute Abdominal Pain: Impact on Radiation Exposure and Multiple Imaging Testing.Journal of medical radiation sciences · 2026Article
- No more waiting: 10 tips to turn kidney transplantation green.Clinical kidney journal · 2026Review
- Reducing unnecessary coagulation screening in ambulatory patients in the emergency departments of a multi-site trust: a quality improvement project.Cost effectiveness and resource allocation : C/E · 2026Article
- Green transplant: A scoping review of sustainability challenges and opportunities in transplantation.World journal of transplantation · 2026Review
- The carbon footprint of group and save in elective and emergency surgery.Annals of the Royal College of Surgeons of England · 2026Article
- Frequency of Routine Bloodwork Among Patients With Chronic Kidney Disease: A Narrative Review to Inform Appropriateness of Care.Canadian journal of kidney health and disease · 2026Review
- Article
- Carbon Reporting Practices in the NHS: Emissions and Omissions Relating to Artificial Intelligence.Journal of medical Internet research · 2025Article
- Article
- Article
- Eight Ways General Internists Can Practice High-Value, Low-Carbon Care: The Canadian Society of Internal Medicine's Climate Conscious Choosing Wisely Canada Recommendations.Journal of general internal medicine · 2025Article
- Article
- Reducing the environmental burden of unnecessary investigations.Canadian family physician Medecin de famille canadien · 2025Article
- Diagnostic stewardship - optimization of superficial wound swab cultures can reduce the environmental impact of the microbiology laboratory.Access microbiology · 2025Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo characterise the extent of unnecessary care in general surgery inpatients using a triple bottom line approach.
designPatients with uncomplicated acute surgical conditions were retrospectively evaluated for unnecessary bloodwork according to the triple bottom line, quantifying the impacts on patients, healthcare costs and greenhouse gas emissions. The carbon footprint of common laboratory investigations was estimated using PAS2050 methodology, including emissions generated from the production, transport, processing and disposal of consumable goods and reagents.
settingSingle-centre tertiary care hospital.
participantsPatients admitted with acute uncomplicated appendicitis, cholecystitis, choledocholithiasis, gallstone pancreatitis and adhesive small bowel obstruction were included in the study. 304 patients met inclusion criteria and 83 were randomly selected for in-depth chart review.
main outcome measuresIn each patient population, the extent of over-investigation was determined by comparing ordered laboratory investigations against previously developed consensus recommendations. The quantity of unnecessary bloodwork was measured by number of phlebotomies, tests and blood volume in addition to healthcare costs and greenhouse gas emissions.
results76% (63/83) of evaluated patients underwent unnecessary bloodwork resulting in a mean of 1.84 phlebotomies, 4.4 blood vials, 16.5 tests and 18 mL of blood loss per patient. The hospital and environmental cost of these unnecessary activities was $C5235 and 61 kg CO
conclusionsWe found considerable overuse of laboratory investigations among general surgery patients admitted with uncomplicated acute surgical conditions resulting in unnecessary burden to patients, hospitals and the environment. This study identifies an opportunity for resource stewardship and exemplifies a comprehensive approach to quality improvement.
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