• Steven Musca, Shilpa Desai, Brigit Roberts, Timothy Paterson, and Matthew Anstey.
• Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia. steven.musca@gmail.com.
• Crit Care Resusc. 2016 Sep 1; 18 (3): 213-7.

ObjectiveTo test a simple clinical guideline to reduce unnecessary routine testing of coagulation status.Design, Setting And ParticipantsA 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).InterventionWe introduced a clinical guideline and educational program in the ICU from 18 August 2015.Main Outcome MeasuresThe number of coagulation tests performed per patient bed-day, and the associated pathology costs.ResultsOver 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.ConclusionA simple clinical guideline and educational package reduced unnecessary coagulation tests and costs in a tertiary referral ICU.

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