Treating Vitamin D Deficiency Empirically

This quality improvement project evaluated the clinical utility of routine vitamin D testing in frail elderly patients admitted to the Acute Surgical Unit. Baseline data demonstrated that the majority of patients had suboptimal vitamin D levels, with significant variability in repeat testing and frequent prescribing errors, particularly confusion between loading and maintenance regimens. Testing rarely altered management, as patients with sufficient levels were typically already on supplementation.

In response, an empirical supplementation pathway was developed, removing vitamin D testing from routine frailty blood panels and promoting guideline-based treatment without awaiting results. The intervention was implemented using a PDSA cycle, including junior doctor education and changes to local prescribing practice.

Key outcomes targeted included reduction in unnecessary blood tests, improved prescribing accuracy, and earlier treatment initiation. The project also identified a significant cost-saving potential of approximately £25,000 annually on the unit. A re-audit is planned to assess sustainability and impact on clinical practice.