On this page
The benefits of this project
Benefits for Your Patients
- Reduction in false positive results and therefore, further repeat appointments resulting in less anxiety.
- Less travel to appointments and less time away from work or home life
Benefits for Your Practice
- Reduction in false positive results and therefore, further appointments.
- Reduction in staff time to check results and follow up patients.
- Reduction in appointments needed.
- Savings for the NHS: ALT is cheaper than LFTs. (Costs vary across areas LFT = £45.50 in Tower Hamlets vs £1.52 per test in West Sussex with ALT costs £6.50 in Tower Hamlet vs £0.50 per test in West Sussex
Benefits for The Planet
- Reduction in travel to appointments.
- Reduction in use of blood bottles and assays.
Opportunity for improvement
- This project aims to achieve a reduction in the number of Liver Function Tests (LFT) for patients on statins by following the NICE lipid guidelines, as annual LFT testing is now considered to be largely unnecessary (see disclaimers).
- There are three issues with liver function testing for statin monitoring: 1) The frequency of LFT testing 2) Which LFTs are routinely required 3) Increased chance of false positives with the more tests you request
- Therefore, both a reduction in test frequency and a switch to single alanine transaminase (ALT) testing rather than a full LFT array, may benefit patients, the NHS and the environment by reducing the number of spurious abnormal results, the financial costs of processing tests, and the amount of plastic and reagents needed for the tests
- More than 30 years of statin use have confirmed that statins do not cause liver disease. They may cause a transient elevation of liver transaminases (98% of which are less than three times the upper limit of normal). NICE has confirmed that only one test, either ALT or Aspartate Transaminase (ASP) is needed for routine identification of liver disease.(ALT is preferred as it is usually cheaper.)
- 82 million prescriptions of statins were issued in the UK in 2023. In Sussex, LFT monitoring of patients on statins accounted for 43% of total LFT requests. A study in Tower Hamlets found that making available an ALT-only test for statin monitoring reduced the number of full LFTs requested for that population by 24% in the following year. In the neighbouring area no change was made (control group) and their LFT usage did not alter. In Sussex, this change could lead to an approximate reduction of 50,000 full LFT tests per year with a switch to ALT tests instead.
- You might like to create SMART goals for your project such as increasing the number of standalone ALTs requested for statin monitoring to 50% of all requests over a 6 month period.
How to carry out this project
-
Audit number of full LFTs vs ALT tests checked over the last 3 months in patients who are also prescribed statins
Run a computer search to look for the number of full LFTs and the number of just ALT tests checked over the last 3 months in patients who are also prescribed statins.
We hope to provide downloadable IT searches for EMIS & SystmOne soon. In the meantime, you could use our EMIS and SystmOne search guides to create your own.
-
Education Session
Hold an education session with your clinicians (GPs, nurses, pharmacists) to make sure everyone is aware of the updated NICE guidance for statin monitoring from December 2023. Explain your QIP and what you will be monitoring. Back this up with email reminders and other forms of communications e.g. newsletter.
-
Re-audit
Re-audit the QIP 3 months after the education session to see what change has occurred. Use the Project Monitoring form to keep track.
-
Review and Feedback
Review and feedback the results to clinicians to remind them of the change and to summarise learning, share with practice team and decide if any changes are needed to improve the process. Use the Project Monitoring Form to keep track. Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches.
Top tip
You might need to remind your team about requesting ALT only quite a few times before everyone adopts this change.
We found it helpful to chat directly to clinicians who kept ordering LFTs to change requests across the board
How to scale this project up or down
| Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members. |
Contact your pathology department requesting the email address for the Head of Efficiency and/or the Consultant Chemical Pathologist to ask if ALT could be added as a stand-alone test for statin monitoring (if it is not already available in your area).
Share your QIP findings with practices in your PCN, Federation, ICB (England) or Cluster, Health Board (Scotland or Wales) or GP federation, Health Trust (Northern Ireland), so the learning can be shared and the project easily implemented by other practices too.
Have you completed this QIP?
Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost savings and other benefits. This project may help with CQC evidence submission (see disclaimers).
More project guides
-
Extreme Cold Weather Alert QIP
Carbon saving potential: Solid
<10 hours
-
Bath & Shower Emollient Deprescribing
Carbon saving potential: High
<10 hours
-
Reducing Emissions Associated with Banking
Carbon saving potential: Very high
20-40 hours
-
Switching Energy Provider
Carbon saving potential: Very high
<10 hours