Improving Surgical Delays Related to Pediatric Preoperative Pregnancy Testing

Abstract

Introduction Preoperative pregnancy status is a vital measure necessary for patient safety. At our institution, missing or delayed pregnancy test results, measured by human chorionic gonadotropin (HCG) levels, were identified as a contributing factor to surgical delays. Methods A quality improvement project was initiated in 2020 at a free-standing children’s hospital after missing or delayed HCG results were identified as a cause of surgical delays. A team was created to specifically evaluate this problem and devise an intervention. As a result, an automatically generated HCG test order was established to address surgical delays associated with missing or delayed HCG test results. The automatic order is triggered when the patient’s initial admission order is activated. For female patients 9 through 11 years of age, an order is automatically generated only if the admitting physician answers “No” to the question “Is the patient premenses?” when prompted. The system automatically generates an order for all female patients greater than 12 years of age regardless of menstruation. Results Pre-intervention data revealed approximately 6% of surgical cases were delayed because of pregnancy test results; post-intervention data revealed approximately 2.6% of surgical cases were delayed because of pregnancy test results. Conclusion Initiation of an automatically generated HCG test order helped achieve the overall goal of reducing surgical delays linked to missing or delayed HCG results. Continued education and collective efforts are underway to help ensure the automatic order’s continued success.