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

Thank you for your encouragement, and for helping to raise awareness on this topic! The guideline does state that "If someone is medically fit for discharge, they do not need routine bloods unless these form part of the ongoing care plan,” which is especially relevant in geriatrics where many patients are already stable.

Thank you also for your suggestion about cost savings! The audit was indeed inspired by a desire to reduce unnecessary cost, but it was quite difficult to obtain exact cost data hence not included. Nonetheless, reducing inappropriate testing will undoubtedly have a significant impact on expenditure, and it is worth looking into the figures!

Thank you so much for your comment! We definitely believe that this QIP can be applied to different Trusts and we take your comment on board. Thank you for sharing with your colleagues!

Thank you! The initial response from colleagues was surprise that such guidelines even existed. Having clear criteria made it easier to justify not repeating bloods unnecessarily, which I think brought more of a sense of relief.

Thank you for your feedback! Not many colleagues, especially from a senior perspective, were resistant to the change and were happy to comply with guidelines on the frequency of blood testing to improve patient comfort.

Thank you! Absolutely - educating colleagues to see that 'doing less' can actually mean providing safer, more responsible care is so important. 

Thank you for your comment! We also hope that our project continues both in our Trust and can also be applied to other Trusts to allow for service improvement.

Thank you! I completely agree — it’s so easy to request more tests than actually needed, especially when they use the same bottle. But we often forget about the downstream impact on lab workload and cost. I’m not sure if your trust has this, but at ours, we can add on tests to existing samples kept in the lab for a few days — a much better approach than ordering tests “just in case.”

Thank you for your insightful comment! We definitely agree that it is easy to order additional blood tests on an electronic system, which is one of the factors that we took into account in our project. Thank you for bringing this topic into your trust, we definitely believe that it should be applied to geriatrics wards nationally.

Interesting to hear what other trusts do! My trust also is trying to encourage at most once weekly bloods for MOFD patients, limiting it to only FBC and U&E. The guideline does say that 'If someone is medically fit for discharge, they do not need routine bloods, unless these form part of the ongoing care plan.' So perhaps, we do need to think about this a bit more! Especially on geriatric wards where we have many more MOFD patients awaiting other things like PT/OT or social reasons.

Thank you! I completely agree. The ease of ordering tests electronically can make over-requesting tempting, speaking from personal experience as well! But hopefully by education and by fostering a more reflective practice environment, this can be gradually reduced.

Thank you! Agree that this is applicable both to hospital and community care. In fact, there is an NHS guidance titled 'Optimising blood testing in primary care' which is really helpful for community settings. Good point about reflective practice - in fact I think it is the key for sustained change to happen. Even encouraging brief moments of reflection during ward rounds or handovers, like asking 'Do we really need this test?' can help to normalise reflective practice. 

Thank you! We didn't know there were national guidance as well up until we were thinking of this audit, so we're hoping to spread that awareness!

It is indeed! Sometime we request it with a 'just in case' mindset, but really we should be asking why we want each test before requesting it. We choose the 7 blood tests based on what we thought were most commonly tested in our geriatric wards, and they were all in the national guidance as well.

Thank you! I’m glad you found it relevant. It’s definitely something we can all apply in our day-to-day work!

Thank you for your comment and positive feedback! We hope our QIP have an impact long-term too, with posters on each geriatric ward and educating the next cohort of resident doctors on the frequency of blood testing.

Thank you for your positive feedback! We too are hopeful after seeing that the intervention led to some improvement in the frequency of blood testing. We hope that this will continue long-term, which could be checked with another QIP cycle.

Thank you for your comment! We believe our QIP can be applied nationally and are hopeful that spreading awareness will lead to less unnecessary blood testing in geriatrics wards.

Thank you for your comment! We focused on geriatric wards due to the improved patient comfort that comes with reducing the frequency of blood tests, especially when patients are MOFD. We hope that there will be another QIP cycle after our latest intervention to ensure that these changes are maintained long-term.

Thank you for your comment! We do hope that the positive financial impact will continue or be improved even as awareness increases. The guideline was indeed meant for secondary care across departments, so there is definitely scope to continue this project in the other departments, and to re-audit regularly in the geriatric wards.

Thank you for your comment! We were indeed hoping that this audit would encourage reflection and foster a more 'responsible clinician' thinking. Much work is needed to continue this efforts long-term for sustainable benefit, and hopefully re-auditing this regularly could help.

Thank you for your comment!

Thank you for your encouragement!

Thank you! We hope it helps junior doctors. In my first F1 rotation, I was guilty of requesting all the 'routine bloods' for our surgical patients without clear indication because thats what our seniors taught us. So hopefully this helps!