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JOURNAL ARTICLE
OBSERVATIONAL STUDY
Routine coagulation testing in intensive care.
Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine 2016 September
OBJECTIVE: To test a simple clinical guideline to reduce unnecessary routine testing of coagulation status.
DESIGN, SETTING AND PARTICIPANTS: A prospective, unblinded, observational study of coagulation testing frequency before and after introduction of a simple clinical guideline. We included 253 patients admitted to a tertiary intensive care unit: 100 patients consecutively enrolled before our intervention (May - July 2015) and 153 patients consecutively enrolled after our intervention (August - September 2015).
INTERVENTION: We introduced a clinical guideline and educational program in the ICU from 18 August 2015.
MAIN OUTCOME MEASURES: The number of coagulation tests performed per patient bed-day, and the associated pathology costs.
RESULTS: Over the 3-month sample period, 999 coagulation profiles were performed for 253 patients: 720 (72%) in 100 patients before, and 279 (28%) in 153 patients after our intervention. The testing frequency fell from 1.12 to 0.41 per patient bed-day (P < 0.001). A total of 463 pre-intervention coagulation profiles (64%) were classified as unnecessary, and the cost of all coagulation tests fell by 60.5% per bedday after the intervention.
CONCLUSION: A simple clinical guideline and educational package reduced unnecessary coagulation tests and costs in a tertiary referral ICU.
DESIGN, SETTING AND PARTICIPANTS: A prospective, unblinded, observational study of coagulation testing frequency before and after introduction of a simple clinical guideline. We included 253 patients admitted to a tertiary intensive care unit: 100 patients consecutively enrolled before our intervention (May - July 2015) and 153 patients consecutively enrolled after our intervention (August - September 2015).
INTERVENTION: We introduced a clinical guideline and educational program in the ICU from 18 August 2015.
MAIN OUTCOME MEASURES: The number of coagulation tests performed per patient bed-day, and the associated pathology costs.
RESULTS: Over the 3-month sample period, 999 coagulation profiles were performed for 253 patients: 720 (72%) in 100 patients before, and 279 (28%) in 153 patients after our intervention. The testing frequency fell from 1.12 to 0.41 per patient bed-day (P < 0.001). A total of 463 pre-intervention coagulation profiles (64%) were classified as unnecessary, and the cost of all coagulation tests fell by 60.5% per bedday after the intervention.
CONCLUSION: A simple clinical guideline and educational package reduced unnecessary coagulation tests and costs in a tertiary referral ICU.
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