Rationalising Blood Tests in the Elderly: An Audit of Routine Blood Investigation Requests in Geriatric Wards

Introduction

Blood tests are frequently ordered in geriatric wards, often without clear clinical justification. This can lead to patient discomfort, increased costs, and unnecessary workload on staff and laboratory services. This audit aimed to evaluate the frequency and appropriateness of blood test ordering and reduce unnecessary investigations in geriatric wards.

Method

We reviewed blood tests ordered over a 2-week period across the four geriatric wards at Leicester Royal Infirmary. Seven commonly requested tests were included: full blood count (FBC), urea and electrolytes (U&E), C-reactive protein (CRP), liver function tests (LFT), coagulation screen (Coag), bone profile, and B-type natriuretic peptide (BNP). Each test was assessed against a predefined criterion based on a proposed local guideline adapted from national recommendations.

Results

A total of 1,918 blood tests were performed during the initial audit, of which 907 (47%) were deemed unnecessary. Bone profile (53%) and coagulation screen (52%) had the highest rates of inappropriate requests. These findings were presented at a consultant meeting and departmental teaching, where reasons for over-ordering were explored and solutions discussed. Guidelines were circulated, and posters were displayed in all wards.

A second audit cycle showed some improvement: 1,638 blood tests were performed, with 721 (44%) found to be unnecessary. The most notable improvement was in coagulation screen requests, which decreased from 52% to 43%.

Conclusion

Nearly half of the blood tests ordered in geriatric wards were unnecessary, highlighting a need for more judicious test ordering. Interventions including education, guideline dissemination, and visual prompts led to a modest reduction in inappropriate testing. Continued efforts are required to reinforce appropriate testing and promote sustainable change in clinical practice.