Using evidence-based techniques to modify anemia screening practice

Routine screening of adolescents for iron-deficiency anemia is a widespread but unproven practice. Using evidence-based quality improvement techniques, including literature synthesis and presentation of clinic-specific data, my colleagues and I reevaluated a clinic policy of obtaining complete blood counts to screen for anemia in all new adolescent patients. Medical record review revealed clinically unsuspected anemia in 8 (3.5) of 229 patients screened. All cases were mild, and only two patients received iron therapy. These data, coupled with national recommendations, led to a reversal of the clinic's policy requiring screening of all new patients. One year later, complete blood counts were obtained for only 6% of new patients.