Quality Improvement Effort Cuts Peds Inpatient Electrolyte Testing

A multifaceted quality improvement intervention can significantly and rapidly cut electrolyte testing among pediatric inpatients, according to a study published April 4 in Pediatrics. Furthermore, the authors show that the reduction in testing yielded financial savings and was not associated with unintended adverse events, suggesting that much of the previous electrolyte testing had been unnecessary.

Cincinnati Children's Hospital aimed to reduce electrolyte testing within the hospital medicine service by at least 25 percent within 6 months. All panels that contained at least one electrolyte test, as well as individual electrolyte tests, were targeted. The group used multiple interventions that included education about the clinical value of electrolyte testing and the costs of testing (session and emails), individual feedback on ordering practices, standardized communication about an electrolyte testing plan, and removal of daily repeating orders in the electronic ordering system. Testing rates and costs for the nine months following the intervention were compared to those at baseline (from Jan. 1, 2015, to Aug. 1, 2016).

The researchers found that at baseline the mean rate of electrolyte testing was 2.0 laboratory draws per 10 patient days. In the two months following the initial education intervention, this rate decreased by 35 percent to 1.3 electrolyte laboratory draws per 10 patient days. Similarly, the number of individual laboratory test results decreased from 18.4 to 13.5 test results per 10 patient days. The number of test results further dropped to 9.5 test results per 10 patient days following the rollout of the cost reference cards, the laboratory plan template in patient notes, and structured rounds discussion. This 48 percent reduction in test results was sustained throughout the rest of the intervention period.

"Our study's success may in part be traced to the breadth of interventions that encouraged discussions of necessity and value in testing and reduced overuse of

testing," write the authors led by Michael J. Tchou, M.D., from Cincinnati Children's Hospital Medical Center in Ohio. "Single interventions in isolation, such as a cost display without relevant education about overuse and value, may not lead to the desired behavior change."

Patient charges for electrolyte testing were cut by nearly one-third—from a mean

$53.81 per patient day to $38.22, which corresponds to an estimated $292,000 of savings per year. This savings was in part due to the substantial reduction in the use of the hospital's highest-charge electrolyte panel, which decreased from 67 percent to 22 percent of all electrolyte testing. During the intervention, there were no changes in rates of medical emergency team calls or readmissions.

In addition to cost savings, the authors say that by reducing overuse the number of test results that need to be reviewed, this could improve workflow for "frontline" staff, thus creating "time for other value-added work."

Takeaway: Quality improvement efforts can safely cut rates of electrolyte testing in pediatric hospitals without jeopardizing patient safety.