Experts make the case for ending routine blood tests

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The practice of ordering routine blood tests (“routine bloods”) for patients attending hospital regardless of clinical need is wasteful and potentially damaging, argue experts.

Alastair Faulkner from Ninewells Hospital, Dundee and colleagues say the practice “may be acting as a psychological comfort blanket for clinicians, masking over-reliance on investigations or under-confidence in clinical judgement.”

They explain that although the UK spends less per capita on laboratory tests than other economically developed nations, there is “growing evidence of the extent of unwarranted variation in spending by  National Health Service (NHS) acute hospitals” and “it is at least possible that overuse of blood tests is an important source of such variation.”

They acknowledge that blood tests remain important diagnostic tools, but argue that “fear of missing important clinical details and the potential for subsequent litigation are intuitively drivers for unnecessarily ordering tests.”

Clinicians need to rethink what counts as “routine,” they write. When it comes to the ordering laboratory tests there should be nothing “routine” about decision making which can impact both patient care and NHS finances.

“As clinicians, we have a duty to lead culture change as effective stewards of clinical resources, who are capable of playing an active part in the long term sustainability of our health service. For an NHS in the current political and economic climate, the stakes could not be higher,” they conclude.

BMJ material
BMJ opinion

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