ArticleCost effectiveness and resource allocation : C/E2026
Reducing unnecessary coagulation screening in ambulatory patients in the emergency departments of a multi-site trust: a quality improvement project.
Article in Cost effectiveness and resource allocation : C/E, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMany Emergency Departments (EDs) front-load investigations, which can cause unnecessary over-investigation in ambulatory patients and has environmental and financial impacts. Coagulation screens often contribute little to patients' management and NHS England guidelines already exist regarding coagulation screening in the ED. Literature has demonstrated successful reductions in coagulation screening but have often lacked balancing measures.
methodsThe number of coagulation and Full Blood Count (FBC) tests performed on ambulatory patients attending a multi-site Trust with 2 Emergency Departments were collected from 2023 to 2025. Total number of coagulation screens and coagulation: FBC ratio were measured and a proxy for repeat venepuncture measured. Interventions were introduced at the John Radcliffe, Oxford, a Major Trauma Centre and at the Horton General Hospital, a District General Hospital.
interventionsInterventions were implemented through PDSA cycles, including posters, moving the location of the coagulation bottles, other specialty involvement and a survey to highlight educational needs. The project was highlighted at regular nursing and medical meetings.
resultsThe decrease in the number of coagulation screens and the coagulation: FBC ratio was gradual and sustained: at 28 weeks, there was a decrease of 26.97% and 28.51%, respectively with no increase in the proxy measure for repeat coagulation or D-Dimer sampling, but there was an increase in the number of patients who had a D-Dimer retrospectively added to their previous sample. Projected annual cost savings were £81,700 - £86,400 and ~ 250 kg CO₂2 per annum.
conclusionsEnvironmental and financial savings can be made by reducing coagulation screening in Major Trauma Centres and across EDs within the same Trust, in keeping with existing literature. This did not appear to be associated with increases in repeat phlebotomy.
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