E015 Greener Rheumatology services: reducing unnecessary ESR testing

Abstract Background/Aims Erythrocyte Sedimentation Rate (ESR) has traditionally been used to assess inflammation in rheumatological conditions. Despite the introduction of C-reactive protein (CRP) testing in the 1980s-90s, ESR remained widely used due to the initial cost and limited availability of CRP. Educational materials and clinical guidelines have historically emphasised ESR. However, simultaneous testing of ESR and CRP for monitoring inflammatory arthritis, giant cell arteritis (GCA), and polymyalgia rheumatica (PMR) is often unnecessary, as CRP alone is sufficient in many cases. CRP offers several advantages: it is less affected by non-inflammatory factors and is significantly more cost-effective (<£2 vs. £20.36 per test). Despite this, dual ordering remains common, partly due to legacy scoring tools such as DAS-28. ESR testing also has a greater environmental impact, requiring more materials, energy, and generating more waste. Methods This quality improvement project aimed to reduce unnecessary ESR testing when CRP was also ordered across Clyde rheumatology services (three hospital sites). Pre-intervention data were collected in November 2024; post-intervention data from March-June 2025. Interventions included: education at rheumatology MDT meetings; targeted reminders to medical day bed unit staff; monthly progress updates via email; removal of ESR from standard biologic screening panels; education to orthopaedics on CRP-only testing for swollen joints and rheumatology referrals. Results In November 2024, 626 ESR and CRP tests were ordered on the same day. By June 2025, this fell to 479—a 23.5% reduction. Orders from the rheumatology team decreased from 231 to 154, representing a 33.3% reduction. These results demonstrate the effectiveness of targeted interventions in reducing unnecessary test utilisation. Conclusion Simple, targeted behavioural interventions can significantly reduce unnecessary ESR testing, yielding substantial cost savings (>£3000/month) and environmental benefits. These changes support realistic medicine principles by avoiding unnecessary investigations. Future plans include updating TrakCare blood order sets and extending education to Primary Care on appropriate ESR use. Disclosure M. Jaffery: None. G. Roberts: None. S. Maunick: None.