Reducing Unnecessary Postoperative Complete Blood Count Testing in the Pediatric Intensive Care Unit
Maya Dewan1, Jorge Galvez2, Tracey Polsky3
1Instructor in the Division of Critical Care Medicine at the Cincinnati Children's Hospital Medical Center in OH. maya.dewan@cchmc.org.
Insights
Reducing routine complete blood count (CBC) testing in pediatric intensive care units (PICUs) is feasible. This quality improvement initiative successfully decreased unnecessary CBCs without impacting patient transfusion needs.
Area of Science:
- Pediatric Intensive Care
- Quality Improvement Science
- Laboratory Medicine
Background:
- Complete blood count (CBC) testing is frequently ordered postoperatively, often considered routine.
- There is a need to reduce unnecessary laboratory testing in low-risk patient cohorts.
Purpose of the Study:
- To decrease routine postoperative CBC testing by 50% in 6 months within a PICU.
- To assess the impact of reduced CBC testing on transfusion rates and patient outcomes.
Main Methods:
- A quality-improvement study using Plan-Do-Study-Act cycles.
- Data collection on laboratory ordering, transfusion requirements, and stakeholder attitudes.
- Interventions included education, audit, and feedback to clinicians.
Main Results:
- Sustained reduction in routine postoperative CBC testing exceeded the 50% goal.
- No increase in hemoglobin levels below 8 g/dL or surgery-related blood transfusions.
- Estimated hospital charges decreased by 87%.
Conclusions:
- A simple, data-driven approach can effectively reduce unnecessary laboratory testing in the PICU.
- Avoiding routine postoperative CBCs in identified low-risk patients is feasible and safe.
- This strategy significantly reduces healthcare costs.
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 quality-improvement 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.
