Last week saw another in our departmental audits, with Cris and Georgia H presenting on our use of COAG testing within the department. It was very interesting to see how we order coagulation studies in the ED.
In summary we ordered 554 Coag tests in a single calendar month.
In a detailed anaylsis of a single week’s ordering, we ordered 133 coag tubes within ED.
(it was noted that some were requested by inpatient teams).
When compared to the ACEM Choosing Wisely indications for COAG testing, it was found that:
22/133 were clearly indicated in-line with the above recommendations
16 additional tests were performed in-line with local protocols (ie CODE STROKE), outside indications suggested by ‘Choosing Wisely’.
The remaining tests (85/133) were not clearly indicated based on either the above guideline or local protocol.
Interesting stuff, but not out of keeping with other studies presented by Georgia that looked at over testing of COAGs in the ED (in fact our numbers were around 40% of total tests sent when compared to a similar sized department studied previously in the ED literature.
A key take home for me was the cost of these tests.
A COAG profile costs approx. $19 to perform, and the tube itself costs $10.
Hence the practice (of which I have been guilty) of collecting a COAG tube and sending as a Pmisc in case of a need to later test coagulation is not cost effective, and should be discouraged.
Today’s teaching has continued parallel to the Accreditation visit, and saw Nivene Saad from radiology present some important radiologic lessons, Hector speak on ventilation in the ED patient (always gold) and Claire present some cases with valuable teaching points from her time as the QAS HARU registrar.
Next week will see the usual teaching program with:
8:00-9:00: Bedside teaching and Simulation
9:00-9:30: Module – ALS revision
9:30-10:30: Practical session – plastering
11:00-12:00: Clinical Case presentations
13:00-14:00: Airway Simulation
14:00-17:00: The program (Exam is the next day – this is a revision session only)