Introduction Group and Save samples (G&S) are routinely performed before laparoscopic appendectomies (LA). Cycle-1 of this QIP showed <1% of patients required blood products perioperatively. We recommended and implemented that a G&S request should be at the clinician’s discretion and not routinely performed. Cycle-2 assesses the impact of our recommendation. Method In Cycle-1 patients who had undergone LA and laparoscopic conversion to open appendicectomies between January - December 2018 were identified using Operating Room Management Information System. Patients who had G&S performed and patients receiving blood products were identified using the hospital’s electronic patient records and online pathology reporting service. Patients from December 2019 to June 2020 formed Cycle-2 of this QIP. Results 124 patients were included in Cycle-2 (versus 263 in Cycle-1). 58% of patients had G&S taken (versus 99.6% in Cycle-1). 0.81% required a transfusion post-operatively (versus 0.76% in Cycle-1). The average number of G&S per patient was reduced by 1.19, saving the Trust £23.80 per patient. Conclusions Blood products are not routinely required peri-operatively, therefore G&S should be ordered at the clinician’s discretion. This safely saves the Trust significant cost and improves patient experience by eliminating the discomfort of unnecessary blood tests.

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Lymphadenopathy is a common presentation in surgical assessment units and has numerous differential diagnoses. In one-stop breast clinics, its discovery often raises concerns of malignancy. This case report focuses on the case of a 33-year-old pregnant woman presenting to the breast clinic with a right axillary lump, which was found to be the result of toxoplasmosis.