Removing automated glucose testing

Key learning point

Careful consideration of all blood ordering requests and order sets in line with the concept of ‘resource stewardship’ helps improve value of care through reducing overmedicalisation and low value medicine.

Setting/Patient Group: Trust-wide

Issue to be addressed:

Glucose sampling is automatically performed when included in ‘order com’ sets of laboratory tests, which can be low value to patients, contributing to overmedicalization and resulting in negative environmental impacts.

Intervention:

1.  Identify which order sets routinely include glucose

2.  Assess staff opinions on utility of glucose inclusion in each order set

3.  Consider if removal of glucose would be appropriate, or had potential to increase risk of missed diagnoses, or if replacement with HbA1c would be of higher value.

4. Adjust order sets accordingly

5. Estimate ‘triple bottom-line' impacts. 

Outcomes:

Clinical

• increased diagnostic accuracy for diabetes mellitus and clinical value using alternative tests such as HbA1C if clinically indicated.

Social

• quicker venesection for patient if one less sample taken, therefore less discomfort for patients due to reduced tests.

Environmental

• Estimated carbon savings at 15 kg CO2e/week (780 kg CO2e /year). 

Economic

• Financial savings from reduced glucose tests, average 307 sample bottles (and lab reagents) saved/week.
• Total figure of savings unclear