Pause the Draws: A Quality Improvement Project to Minimize Unnecessary Liver Function Tests in a Small District General Hospital

Introduction Blood tests are essential for diagnosis and monitoring in hospital settings, yet many are performed without clear clinical benefit. Unnecessary blood testing can negatively affect patients by prolonging hospital stays, disrupting sleep, and prompting further investigations that may not be needed, while also adding avoidable financial costs and carbon emissions. This quality improvement project focused on reducing inappropriate liver function tests (LFTs) in two medical wards, following the Royal College of Pathology (RCPath) guidelines, with the aim of halving the proportion of inappropriate tests. Our initial audit identified that 28% of LFTs performed on the wards were unnecessary, demonstrating a clear opportunity for improvement. Methods The extent and causes of unnecessary LFTs were identified across two medical wards. Following the RCPath guidelines, any LFT repeated within 72 hours of a previous test was considered inappropriate unless an exclusion criterion applied. Interventions were implemented over four Plan-Do-Study-Act (PDSA) cycles. Weekly data were collected on the total and inappropriate number of LFTs for every patient present on the wards on Fridays. For each inappropriate LFT, the request information was reviewed to assess the rationale and inform subsequent PDSA cycles. Results Across the four PDSA cycles, inappropriate LFTs decreased from 72 out of 257 (28.0%) to 18 out of 98 (18.4%). The weekly LFT carbon footprint decreased from 263.34 kgCO₂e to 83.2 kgCO₂e. The weekly cost of unnecessary LFTs was reduced from £140.79 to £44.46. Conclusions The reduction of inappropriate LFTs yielded measurable clinical, environmental, and financial benefits. Patients avoided unnecessary blood tests that could complicate or prolong their admissions. Cost savings were demonstrated, and the hospital's carbon footprint was reduced. The project's impact, achieved through simple and practical interventions, highlights that physician education is central to optimizing blood testing.