Reducing Blood Testing in Pediatric Patients After Heart Surgery

Delgado-Corcoran, Claudia; Bodily, Stephanie; Frank, Deborah U.; Witte, Madolin K.; Castillo, Ramon; Bratton, Susan L.

doi:10.1097/pcc.0000000000000194

Cited by 18 publications

(16 citation statements)

References 16 publications

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“…46,47 Regarding intervention complexity, all interventions included a system-and/or process-based change component. In addition to this component, 2 studies included education, 45,48 1 study included audit and feedback, 49 and 4 studies included both education and audit and feedback components alongside a system-and/or process-based change. 46,47,50,51 Three studies contained examinations of only a system-and/or process-based change.…”

Section: Interventions Targeting Pathology Onlymentioning

confidence: 99%

Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review

et al. 2018

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Section: Interventions Targeting Pathology Onlymentioning

confidence: 99%

Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review

et al. 2018

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“…10 Prior studies to reduce laboratory testing have mainly focused on restriction through the use of limitations in the clinician computer order entry system. [5][6][7][8] By limiting the use of standing or repeating laboratory orders, we were able to demonstrate sustained decreases in laboratory testing. Other interventions have focused on displays of cost data to encourage decreased utilization of testing, and although successful, the decreases have been small (less than 10%).…”

Section: Discussionmentioning

confidence: 89%

“…[5][6][7] In postoperative pediatric cardiac patients, interventions removing standing laboratory order panels have resulted in decreased utilization of laboratory testing with no resultant differences in mortality or extubation failure. 8 We sought to develop a unique evidence-based approach to reducing laboratory testing in low-risk postoperative patients in the PICU.…”

Section: Introductionmentioning

confidence: 99%

Reducing Unnecessary Postoperative Complete Blood Count Testing in the Pediatric Intensive Care Unit

Dewan

Gálvez

Polsky

et al. 2017

TPJ

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Context: Complete blood count (CBC) testing commonly occurs to determine the need for blood transfusions after surgical procedures. Many clinicians believe postoperative CBCs are "routine."Objective: To decrease unnecessary routine CBC testing in a low-risk cohort of postoperative patients in the pediatric intensive care unit (PICU) at The Children's Hospital of Philadelphia by 50% in 6 months.Design: Quality-improvement study. Data from our institution regarding frequency of ordering laboratory studies and transfusion requirements were collected for prior qualityimprovement work demonstrating the safety and feasibility of avoiding routine postoperative CBCs in this cohort. Baseline survey data were gathered from key stakeholders on attitudes about and utilization of routine postoperative laboratory testing. Patient and clinician data were shared with all PICU clinicians. Simple Plan-Do-Study-Act cycles involving education, audit, and feedback were put into place.Main Outcome Measures: Percentage of postoperative patients receiving CBCs within 48 hours of PICU admission. Balancing measures were hemoglobin level below 8 g/dL in patients for whom CBCs were sent and blood transfusions up to 7 days postoperatively for any patients in this cohort.Results: Sustained decreases below our 50% goal were seen after our interventions. There were no hemoglobin results below 8 g/dL or surgery-related blood transfusions in this cohort within 7 days of surgery. Estimated hospital charges related to routine postoperative CBCs decreased by 87% during 6 postintervention months.Conclusion: A simple approach to a systemic problem in the PICU of unnecessary laboratory testing is feasible and effective. By using local historical data, we were able to identify a cohort of patients for whom routine postoperative CBC testing is unnecessary.

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“…In this issue of Pediatric Critical Care Medicine, Delgado-Corcoran et al (10) should be commended for their work demonstrating the ability to decrease costs by reducing blood testing in a pediatric cardiac unit and not compromising care. In their single center, prospective study conducted at a pediatric heart center, cost reduction was significant in all but the least complex surgical categories.…”

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confidence: 99%

“…Pediatric critical care has generally not been held to any standards of cost containment, but it would be foolish to ignore that this is coming, and coming quickly. Delgado-Corcoran et al (10) have provided an example of how to satisfy the demands of our patients and payers. We would do well to follow their example.…”

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confidence: 99%