Reducing Unnecessary Venous Blood Gas (VBG) Testing in the Emergency Department Through Targeted Education

Kelly Mullins,1 Kate Urie,1 Kate Wallis,1 Brendan Morrissey,1 Sam Freeman,1,2 Christina M Trambas,3 Hamed Akhlaghi1,2,4 1Department of Emergency Medicine, St Vincent’s Hospital (Melbourne Ltd), Melbourne, VIC, Australia; 2Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia; 3Department of Pathology, St Vincent’s Hospital (Melbourne Ltd), Melbourne, VIC, Australia; 4Faculty of Health, Deakin University, Melbourne, VIC, AustraliaCorrespondence: Hamed Akhlaghi, Department of Emergency Medicine, St Vincent’s Hospital (Melbourne Ltd), 43 Victoria Parade, Fitzroy, Melbourne, VIC, Australia, Tel +61 3 9231 2211, Email [email protected]: Our objective was to evaluate the amount of unnecessary Venous Blood Gas (VBG) tests initiated in the Emergency Department (ED) and to assess the effectiveness of clinical intervention, such as education, in reducing VBG tests.Methods: 497 consecutive patients were selected between 1 August and 30 September 2019. For Phase 1, 10 volunteer nurses were randomly assigned to 50 cases each and assessed whether they would perform a VBG. A brief educational intervention was then implemented regarding specific clinical indications to perform VBGs. After the education, they were asked the same questions. For Phase 2, the entire ED team was subjected to intervention and education (Phase 2). A monthly prospective audit of VBG testing numbers in St Vincent’s Melbourne Emergency Department was compared from March 2022 to December 2022.Results: The phase 1 educational intervention saw a significant reduction in unnecessary VBG of 24% (p-value < 0.001, odd ratio of 15.8 [confidence interval (CI): 8.5– 29.1]). During Phase two, a sustained reduction in absolute VBG testing in the ED was observed of 33.7% (9% adjusted reduction). This simple intervention would save around &dollar;22,000 in our ED based on an annual presentation of ~50,000.Conclusion: Our study highlights the importance of education to support the “Choosing wisely” campaign to reduce VBG testing in EDs. By reducing the number of VBGs, we not only limit unnecessary tests for our patients, but also reduce the cost associated with frequent and unnecessary blood gas analysis.Plain Language Summary: Our study highlights the importance of education to support the “Choosing wisely” campaign to reduce VBG testing in the Emergency Department.Keywords: venous blood gas, emergency department, Choosing Wisely, intervention, education