Reducing unnecessary coagulation screening in ambulatory patients in the emergency departments of a multi-site trust: a quality improvement project

Journal article

Background: Many Emergency Departments (EDs) front-load investigations, which can cause unnecessary over-investigation in ambulatory patients and has environmental and financial impacts. Coagulation screens often contribute little to patients’ management and NHS England guidelines already exist regarding coagulation screening in the ED. Literature has demonstrated successful reductions in coagulation screening but have often lacked balancing measures. Methods: The number of coagulation and Full Blood Count (FBC) tests performed on ambulatory patients attending a multi-site Trust with 2 Emergency Departments were collected from 2023 to 2025. Total number of coagulation screens and coagulation: FBC ratio were measured and a proxy for repeat venepuncture measured. Interventions were introduced at the John Radcliffe, Oxford, a Major Trauma Centre and at the Horton General Hospital, a District General Hospital. Interventions: Interventions were implemented through PDSA cycles, including posters, moving the location of the coagulation bottles, other specialty involvement and a survey to highlight educational needs. The project was highlighted at regular nursing and medical meetings. Results: The decrease in the number of coagulation screens and the coagulation: FBC ratio was gradual and sustained: at 28 weeks, there was a decrease of 26.97% and 28.51%, respectively with no increase in the proxy measure for repeat coagulation or D-Dimer sampling, but there was an increase in the number of patients who had a D-Dimer retrospectively added to their previous sample. Projected annual cost savings were £81,700 - £86,400 and ~ 250 kg CO₂2 per annum. Conclusions: Environmental and financial savings can be made by reducing coagulation screening in Major Trauma Centres and across EDs within the same Trust, in keeping with existing literature. This did not appear to be associated with increases in repeat phlebotomy.

Authors: Conway, R; Solesbury, N

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: Cost Effectiveness and Resource Allocation
• Volume: 24
• Issue: 1
• Article number: 63
• Publication date: 2026-03-30
• Acceptance date: 2026-02-02
• DOI: 10.1186/s12962-026-00726-z
• EISSN: 1478-7547
• ISSN: 1478-7547
• Language: English
• Keywords: Ambulatory; Psychological intervention; Venipuncture; Specialty; Coagulation testing; Coagulation; Health services research; Quality management