Related Experiment Video
Updated: Apr 26, 2026
A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy
Reducing blood testing in pediatric patients after heart surgery: a quality improvement project
Claudia Delgado-Corcoran1, Stephanie Bodily, Deborah U Frank
11Division of Pediatric Critical Care Medicine, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT. 2Department of Systems Improvement, Primary Children's Hospital, Salt Lake City, UT.
Insights
Optimizing blood testing in pediatric cardiac surgery safely reduced test volumes and costs by 32%. This initiative also decreased packed red blood cell transfusions in complex cases without impacting patient outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Quality Improvement
- Healthcare Management
Background:
- Pediatric cardiac surgical patients often undergo frequent blood testing, contributing to costs and potential complications.
- Optimizing laboratory utilization is crucial for improving efficiency and patient care in pediatric cardiac intensive care units.
Purpose of the Study:
- To implement and evaluate changes in laboratory ordering practices to reduce blood testing in pediatric cardiac surgical patients.
- To assess the impact of these changes on patient outcomes, costs, and transfusion rates.
Main Methods:
- A quality improvement project utilizing pre- and postintervention cohort design in a pediatric cardiac ICU.
- Intervention involved analyzing laboratory ordering processes and modifying practices to limit standing orders and require individualized test requests.
- Patients were stratified by the Risk Adjustment for Congenital Heart Surgery (RACHS) categories.
Main Results:
- A significant reduction in blood tests per patient (38 to 24) and per patient-day (14.4 to 10.4) was observed postintervention (p < 0.0001).
- No significant differences in adverse outcomes, including extubation failure, bloodstream infections, or mortality, were noted between groups.
- Laboratory costs decreased by 32%, and packed red blood cell transfusions were reduced in the most complex surgical patients (RACHS 6).
Conclusions:
- Modifying laboratory ordering practices safely decreased blood testing rates in postoperative pediatric cardiac patients.
- The intervention led to significant cost savings and a reduction in packed red blood cell transfusions for high-risk patients.
Objectives:
To safely optimize blood testing and costs for pediatric cardiac surgical patients without adversely impacting patient outcomes.
Design:
This is a quality improvement cohort project with pre- and postintervention groups.
Setting:
University-affiliated pediatric cardiac ICU in a tertiary care children's hospital.
Patients:
All patients were surgical patients for whom Risk Adjustment for Congenital Heart Surgery categories allowed for stratification by complexity. The preintervention group was treated in 2010 and the postintervention group in 2011.
Interventions:
Laboratory ordering processes were analyzed, and practice changed to limit standing blood test orders and requires individualized ordering.
Measurements And Main Results:
Three hundred nineteen patients were studied in 2010 and 345 in 2011. Groups were similar in median age, weight, length of stay (ICU length of stay), and Risk Adjustment for Congenital Heart Surgery category. There was a reduction in the total blood tests per patient (24 vs 38; p < 0.0001) and length of stay adjusted tests per patient-day (10.4 vs 14.4; p = 0.0001) in the postintervention group. The largest test reductions were blood gases and single electrolytes. Adverse outcomes, such as extubation failure (6.4% vs 5.6%), central catheter-associated bloodstream infection (2.2 vs 1.5), and hospital mortality (0.6% vs 0.6%), were not significantly different between the groups. Cost analysis demonstrated an overall laboratory cost savings of 32%. In addition, the volume of packed RBC transfusions was also significantly decreased in the postintervention group among the most complex patients (Risk Adjustment for Congenital Heart Surgery, 6).
Conclusions:
Blood testing rates were safely decreased in postoperative pediatric cardiac patients by changing laboratory ordering practices. In addition, packed RBC transfusion was decreased among the most complex patients.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:21Cardiac Catheterization II: Right Heart Catheterization
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism