Blood tests over the weekend – who looks at them?

Doing routine bloods over the weekend is still common practice in many hospitals but has very little value unless they are acted upon. Also, as a cost-saving measure, many hospitals have no, or very limited, phlebotomy services over the weekend. So inevitably this job is carried out by the already-stretched on-call team, giving them even less time to admit and review ill patients.

We carried out an audit on seven medical wards (with the exception of medical admission unit) over 2 separate weekends. We reviewed the handover sheets and the medical records to look for specific action plans for patients who had their bloods taken over the weekend.

During the initial audit, 67 investigations were performed, of which only 47 were planned; the rest were carried out either following a review or to determine warfarin dose. Of the 47 investigations that were planned only 5 were handed over with an action plan. It was impossible to determine how many of these results were checked and acted upon, as there was very little documentation in patients’ medical records. Most of the investigations were carried out to monitor electrolytes, sepsis and international normalised ratio (INR). Some planned investigations like haematinics and alpha fetoprotein do not get processed over the weekend and could have been done after the weekend.

We presented the initial results at our departmental meeting and introduced a structured handover sheet that informed the on-call team about the investigations requested over the weekend, why they were requested and what to do with the results. The audit was repeated after 4 months. During the second audit, 39 out of 44 investigations were planned, of which 21 had a proper handover. Even though there was an improvement in handover and a reduction in unplanned investigations, the documentation on what action had been taken was still impossible to find.

This audit highlights the issues over the weekend when the hospital is run by the on-call team with very limited resources. In the current system, many hospitals rely on laboratory staff to flag up abnormal results and inform the nursing or the medical staff. No investigation should be undertaken without an action plan. A structured handover system can address some of the issues, but not all. Limited phlebotomy services increases the burden on junior doctors over the weekend, where the staffing levels are already critical.

The Royal College of Physicians and NHS Improvement documents recommend a high quality care sustainable 24 hours per day, 7 days per week.^1,2 However, this cannot be achieved solely by re-organising the medical rota when other support services are being rationed due to financial reasons.