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[Reduction of complimentary prescription examinations in a pediatric emergency department]
L Surcin1, J Bloch, C Vitout-Brot
1Service de santé publique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019, Paris, France.
Insights
Unnecessary medical tests in pediatric emergency departments were reduced by adding recommendations to request forms. However, these improvements require regular reinforcement to be sustained long-term.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Clinical Practice Guidelines
Background:
- Unnecessary biological tests and X-rays are frequently prescribed in pediatric emergency settings.
- These tests contribute to increased workload, costs, and potential patient harm.
- Targeting common pediatric conditions like bronchiolitis and asthma can address significant areas of overuse.
Purpose of the Study:
- To decrease the number of unnecessary diagnostic tests ordered in a pediatric emergency department.
- To focus on four prevalent pediatric conditions: bronchiolitis, gastroenteritis, unexplained fever, and asthma attacks.
- To evaluate the impact of a simple intervention on test ordering practices.
Main Methods:
- A 'before and after' intervention study design was employed.
- Prescription recommendations were added to existing test request forms.
- Data were collected over two 2-week periods, including all children with the targeted pathologies.
Main Results:
- Test requests per child decreased from 0.98 to 0.77 (p=0.02).
- The proportion of necessary tests increased from 33% to 50% (p<0.0001).
- Unnecessary blood sample rates dropped from 30% to 15% (p=0.01), with no increase in appropriate but unprescribed tests.
Conclusions:
- Modifying request forms with recommendations effectively reduces unnecessary testing in pediatric emergency departments.
- Sustained reduction requires consistent reinforcement of the recommendations.
- This intervention offers a practical approach to improving healthcare efficiency and patient safety.
Unlabelled:
Numerous biological tests and X-rays are prescribed though the patient's clinical status does not warrant them. They are a source of extra work, extra costs, and painful and potential measurement errors.
Objectives:
To reduce unnecessary tests in four frequent situations (bronchiolitis, gastroenteritis, unexplained fever in children more than three months of age, asthma attack) at the pediatric emergency department of the Robert-Debré hospital (Paris).
Methods:
Using a 'before/after' intervention survey, the intervention consisted of a modification of the request forms by adding prescription recommendations. All the children presenting with any one of the four targeted pathologies were included during the two 2-week periods.
Results:
Test requests were reduced from 0.98 test per child to 0.77 (p = 0.02). The percentage of necessary tests increased from 33 to 50% (p < 0.0001); the percentage of children who underwent unnecessary blood samples decreased from 30 to 15% (p = 0.01). At the same time, the percentage of tests which were appropriate but not prescribed did not increase during the intervention period.
Conclusion:
It is possible to reduce unnecessary tests in an emergency pediatric department by adding recommendations to the request form. Unfortunately, the effects of such intervention do not last if the recommendations are not regularly recalled.
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