Abstract
Introduction Critically ill children are at significant risk of repeated blood sampling for laboratory testing, which could lead to nosocomial anaemia and blood transfusions1. We aimed to optimise blood testing and the associated costs in PICU without adversely impacting patient safety and outcome.
Objectives As part of the quality improvement initiative, a bedside guideline for common blood tests was introduced in 2014 based on a patient stratification system. We wanted to check if our practice is compliant with the guideline.
Methods We prospectively measured compliance with the guideline in a randomly selected subset. After doing the first cycle, we presented the results locally along with regular education of PICU medical and nursing staff. We compared the total number of blood tests requested and their costs per patient-day in three days-blocks pre-intervention (October 2019) and post-intervention (January 2020).
Results Prospective audit data showed compliance with the guideline in 8 of 24 (33.3%) patient-days studied. The total number of tests increased from 179 to 191 (% increase) in the post-intervention period. Patient-days had increased from 24 to 39 (% increase) in the corresponding period.
The proportion of patients needing level 3 and 4 care2 was higher in the post-intervention period (48.7% vs. 41.6%). The average number of blood tests requested per patient-day decreased from 7.45 to 4.89 post-intervention, a 34.3% reduction. The average cost per patient-day decreased from £36.6 to £24 post-intervention, a 34.4% cost saving. The savings over 12 months would be £51,458.4 based on 4084 patient-days in 2019. There were no adverse events reported due to lack of blood results
Conclusions Blood testing rates can be safely reduced in critically ill children.
