RT Journal Article
SR Electronic
T1 Anaemia investigation in practice: inappropriate, cost inefficient with a risk of missing gastrointestinal cancer. Can we improve?
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 115
OP 118
DO 10.7861/clinmedicine.10-2-115
VO 10
IS 2
A1 Sheena Mankodi
A1 Bu Hussain Hayee
A1 John O'Donohue
A1 David Reffitt
YR 2010
UL http://www.rcpjournals.org/content/10/2/115.abstract
AB Iron-deficiency anaemia (IDA) is often inappropriately investigated. This study aimed to improve referrals, estimate cost implications and determine effectiveness of referral criteria for diagnosing cancer. Patients referred for investigation of anaemia were studied. IDA was defined as haemoglobin < 12.5 g/dl (M) and < 11.5 g/dl (F), with ferritin < 15 ng/l (if normal erythrocyte sedimentation rate) or mean corpuscular volume < 76 fl. After referral form redesign/trust education, data were recollected. Sixty-six of 118 referred patients had non-IDA with annual cost of inappropriate referrals £176,840. The haematology database identified 37 patients (30 F) with uninvestigated IDA (lost revenue £120,254). After changes, 43/103 referred patients had non-IDA (p<0.05), with an annual saving of £72,600. Fourteen of 112 patients with IDA had cancer versus 4/109 non-IDA (p<0.025), overall prevalence 8.1%. Many referrals for anaemia investigation are inappropriate and a 35% reduction was achieved. The sensitivity and negative predictive value of the referral criteria for diagnosing gastrointestinal cancer were 77.8% and 96.3% respectively.