A quality improvement initiative rapidly reduced unnecessary electrolyte testing among hospitalized pediatric patients, according to a study published online in Pediatrics.
Michael J. Tchou, M.D., from the Cincinnati Children's Hospital Medical Center, and colleagues conducted a quality improvement project targeting use of electrolyte testing among six hospital medicine teams in a large academic children's hospital system.
Despite studies indicating a high rate of overuse, electrolyte testing remains common in pediatric inpatient care. Frequently repeated electrolyte tests often return normal results and can lead to patient harm and increased cost. Researchers aimed to reduce electrolyte testing within a hospital medicine service by >25% within 6 months.
Researchers conducted an improvement project in which we targeted 6 hospital medicine teams at a large academic children’s hospital system by using the Model for Improvement. Interventions included standardizing communication about the electrolyte testing plan and education about the costs and risks associated with overuse of electrolyte testing.
The primary outcome measure was the number of electrolyte tests per patient day. Secondary measures included testing charges and usage rates of specific high-charge panels. They tracked medical emergency team calls and readmission rates as balancing measures.
The mean baseline rate of electrolyte testing was 2.0 laboratory draws per 10 patient days, and this rate decreased by 35% after 1 month of initial educational interventions to 1.3 electrolyte laboratory draws per 10 patient days.
This change has been sustained for 9 months and could save an estimated $292 000 in patient-level charges over the course of a year. Use of our highest-charge electrolyte panel decreased from 67% to 22% of testing. No change in rates of medical emergency team calls or readmission were found.
"Our improvement intervention was associated with a significant and rapid reduction in electrolyte testing and has not been associated with unintended adverse events," the authors write.