Economic and environmental impact of reducing unnecessary coagulation screen testing on an acute medical unit: a quality improvement project

Published Date: 11th February 2026

Publication Authors: Nasher. M, Beveridge. N, Burrows. S, Jones. N, Gurumurthi. S, Gurung. S, Griffiths. B, Wong. W, Varia. R

Background
Inappropriate coagulation testing contributes to inefficiency, cost, and environmental harm. Baseline audits on our acute medical unit (AMU) showed that one-third of coagulation screen requests lacked a clear clinical indication.

Aim
To reduce unnecessary coagulation screens on acute medical services [AMU and Medical Same Day Emergency Care (mSDEC)] by 90% within 12 months, aligned with National Health Service (NHS) Net Zero ambitions and our Trust’s Green Plan.

Methods
Using the Model for Improvement, we conducted three Plan–Do–Study–Act cycles. Our analogue and digital interventions included revised triage order sets, condition-specific electronic order sets, and a digital decision prompt requiring clinicians to confirm test indication. Data were collected at baseline (January–February 2024) and re-audited after interventions (December 2024). Outcome measures were the proportion of inappropriate tests, cost savings, staff time, and carbon reduction.

Results
At baseline, 34%–39% of coagulation screens were inappropriate across AMU areas. Postintervention, inappropriate testing reduced to 20% in mSDEC, 10% in AMU 1B, and 15% in AMU 1C. This equates to a projected annual reduction of 44 000 tests, saving £130 000, 367 staff hours, and 3.6 tonnes CO₂e (equivalent to a 9000-mile car journey). Laboratory workload and plastic waste also fell substantially.

Conclusion
Embedding decision prompts within electronic order systems achieved rapid, sustained reductions in unnecessary testing. This scalable, low-cost intervention aligns clinical practice with sustainability goals and offers a model for reducing unwarranted diagnostics across the NHS. In the face of the climate crisis, aligning practice with environmental goals is both a professional responsibility and an opportunity to improve care, efficiency, and outcomes.

Nasher, M; Beveridge, N; Burrows, S; Jones, N; Gurumurthi, S; Sajjad, A; Gurung, S; Griffiths, B; Wong, W; Varia, R. (2026). Economic and environmental impact of reducing unnecessary coagulation screen testing on an acute medical unit: a quality improvement project. Postgraduate Medical Journal. Online Pub 11 Feb, p.qgag014. [Online]. Available at: https://doi.org/10.1093/postmj/qgag014 [Accessed 20 February 2026].