Reducing the number of orders for coagulation tests in the standard emergency department blood work-up
Ferreras Amez JM, Sarrat Torres MA, Arribas Entrala B, Carrasco Baraja V, Pérez Layo A, Franco Sorolla JM
Affiliation of the authors
Servicio de Urgencias, Hospital Royo Villanova, Zaragoza. Grupo de Trombosis SEMES Aragón, Spain. Servicio de Urgencias, Hospital Royo Villanova, Zaragoza, Spain. Servicio de Hematología, Hospital Royo Villanova, Zaragoza, Spain. Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza. Presidente Grupo de Trombosis SEMES Aragón, Spain.
Ferreras Amez JM, Sarrat Torres MA, Arribas Entrala B, Carrasco Baraja V, Pérez Layo A, Franco Sorolla JM. Reducing the number of orders for coagulation tests in the standard emergency department blood work-up. Emergencias. 2017;29:109-12
Summary
Objective.
To evaluate the usefulness of a clinical protocol developed to reduce the number of orders for coagulation tests.
Methods.
Quasi-experimental study with historical controls. We retrospectively included all patients whose records showed that a coagulation test had been ordered in the emergency department. We analyzed the number of tests ordered under the protocol and the number ordered during the period of standard practice.
Results.
Orders for coagulation tests were given for 657 patients (77.2%) when physicians followed standard practices and for 448 (55.5%) when they followed the protocol (P<.001). Unnecessary tests numbered 431 (65.6%) and 227 (50.6%)
in the standard-practice and protocol periods, respectively (P<.002). One patient (0.15% [95% CI, 0.004%–0.8%]) had significantly altered coagulation (international normalized ratio, 1.8), but none (0% [95% CI, 0%–0.6%]) required treatment and no treatment plans were changed based on a finding of unexpected coagulation disorder.
Conclusions.
The protocol to guide the ordering of coagulation tests has managed to reduce unnecessary tests and thus improve management of this health service resource.
