Reducing Electrolyte Testing in Hospitalized Children by Using Quality Improvement Methods.

Area of Science:

• Pediatric hospital medicine
• Clinical quality improvement
• Laboratory utilization

Background:

• Electrolyte testing is frequently overused in pediatric inpatient settings.
• Overuse leads to increased costs and potential patient harm.
• A >25% reduction in electrolyte testing was targeted within 6 months.

Purpose of the Study:

• To implement and evaluate an intervention aimed at reducing electrolyte testing in pediatric inpatients.
• To decrease the frequency of electrolyte laboratory draws per patient day.
• To assess the impact on healthcare costs and patient safety.

Main Methods:

• A quality improvement project utilizing the Model for Improvement was conducted.
• Interventions included standardized communication and education on testing risks and costs.
• Targeted 6 hospital medicine teams at a large academic children's hospital system.

Main Results:

• Electrolyte testing decreased by 35% from a baseline of 2.0 to 1.3 tests per 10 patient days within 1 month.
• This reduction was sustained for 9 months, with an estimated annual saving of $292,000.
• Usage of the highest-charge electrolyte panel dropped from 67% to 22%.

Conclusions:

• The improvement intervention successfully achieved a significant and rapid reduction in electrolyte testing.
• No adverse events, such as increased medical emergency team calls or readmissions, were observed.
• This strategy effectively optimizes laboratory test utilization in pediatric care.