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Reducing Blood Testing in Pediatric Patients after Heart Surgery: Proving Sustainability

Stephanie A Bodily1, Claudia Delgado-Corcoran1, Katherine Wolpert1

  • 1Division of Pediatric Critical Care Medicine, Primary Children's Hospital, Intermountain Health Care, Salt Lake City, Utah; and Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah.

Pediatric Quality & Safety
|September 20, 2018
PubMed

Insights

A quality improvement initiative successfully reduced blood testing in pediatric cardiac surgery patients. This sustained reduction in laboratory tests may be linked to increased reintubation and arrhythmias in high-risk patients.

Area of Science:

  • Pediatric Cardiac Surgery
  • Quality Improvement in Healthcare
  • Intensive Care Medicine

Background:

  • Frequent blood testing in pediatric intensive care units poses risks such as iatrogenic anemia and infection.
  • A quality improvement (QI) initiative was implemented in 2011 to reduce routine blood testing.

Purpose of the Study:

  • To describe the sustained reduction in blood testing over three years following a QI initiative.
  • To evaluate the impact of reduced blood testing on patient safety and adverse outcomes in post-operative pediatric cardiac surgery patients.

Main Methods:

  • A cohort of post-operative pediatric cardiac surgery patients (N=1169) were studied across preintervention (2010), intervention (2011), and postintervention (2012-13) periods.
  • The QI initiative replaced standing laboratory orders with condition-based testing.
  • Data collected included laboratory studies per patient (labs/pt), labs per patient per day (labs/pt/d), and adverse outcomes (reintubation, infections, mortality).

Main Results:

  • Sustained reduction in labs/pt (38 to 23) and labs/pt/d (15 to 10) was observed post-QI implementation.
  • The postintervention group exhibited higher surgical complexity (RACHS 3-4), younger age, and smaller size.
  • Increased risk of reintubation and arrhythmias was noted in children with RACHS 3-4 classification postintervention.

Conclusions:

  • A QI initiative effectively reduced and sustained lower blood testing rates in young, complex pediatric cardiac surgery patients.
  • The study suggests a potential association between reduced blood testing and increased reintubation and arrhythmias in high-risk (RACHS 3-4) patients, warranting further investigation.
Abstract

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