{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T08:46:32Z","timestamp":1782290792986,"version":"3.54.5"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"1209","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To reduce unnecessary coagulation screens on acute medical services [AMU and Medical Same Day Emergency Care (mSDEC)] by 90% within 12\u00a0months, aligned with National Health Service (NHS) Net Zero ambitions and our Trust\u2019s Green Plan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the Model for Improvement, we conducted three Plan\u2013Do\u2013Study\u2013Act 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\u2013February 2024) and re-audited after interventions (December 2024). Outcome measures were the proportion of inappropriate tests, cost savings, staff time, and carbon reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At baseline, 34%\u201339% 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\u2009000 tests, saving \u00a3130\u2009000, 367 staff hours, and 3.6 tonnes CO\u2082e (equivalent to a 9000-mile car journey). Laboratory workload and plastic waste also fell substantially.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                    <jats:p>Key messages What is already known on this topic \u00a0Inappropriate coagulation testing is common across NHS acute care, with studies showing over one-third of tests lack a clinical indication.Excess diagnostic testing contributes to financial costs, staff workload, plastic waste, and carbon emissions.Previous quality improvement initiatives have focused mainly on education or guideline dissemination, with variable success. What this study adds \u00a0Embedding a simple digital decision prompt into electronic order sets significantly reduced inappropriate coagulation screens across an Acute Medical Unit.The intervention was low-cost, rapidly implemented, and co-designed with frontline clinicians to improve uptake and sustainability.Projected impact includes avoidance of 44\u2009000 tests annually, saving ~\u00a3130\u2009000, 367 staff hours, and 3.6 tonnes CO\u2082e, supporting NHS Net Zero targets.This scalable model demonstrates how small digital changes can drive large improvements in clinical quality, efficiency, and sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/postmj\/qgag014","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:45:29Z","timestamp":1769172329000},"page":"689-692","source":"Crossref","is-referenced-by-count":0,"title":["Economic and environmental impact of reducing unnecessary coagulation screen testing on an acute medical unit: a quality improvement project"],"prefix":"10.1093","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2276-520X","authenticated-orcid":false,"given":"Magda","family":"Nasher","sequence":"first","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Beveridge","sequence":"additional","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy","family":"Burrows","sequence":"additional","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Jones","sequence":"additional","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri","family":"Gurumurthi","sequence":"additional","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aarush","family":"Sajjad","sequence":"additional","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8034-2279","authenticated-orcid":false,"given":"Sweekriti","family":"Gurung","sequence":"additional","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai","family":"Wong","sequence":"additional","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragit","family":"Varia","sequence":"additional","affiliation":[{"name":"Acute Medical Unit , Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside, L35 5DR England, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"2026062403512766500_ref1","volume-title":"Delivering a \u2018Net Zero\u2019 National Health Service","author":"NHS England","year":"2022"},{"key":"2026062403512766500_ref2","volume-title":"Green Plan Guidance","author":"NHS England","year":"2025"},{"key":"2026062403512766500_ref3","volume-title":"St Helens and Knowsley Teaching Hospitals NHS Trust. 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