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Updated: Feb 3, 2026

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Optimizing Utilization of Laboratory Investigations in Neonatal Intensive Care Unit
Sowmya Devarapalli1, Shiv Sajan Saini1, Venkataseshan Sundaram1
1Division of Neonatology, Department of Pediatrics, PGIMER, Chandigarh, India.
Objective:
To optimize utilization of laboratory tests by measuring baseline rates and appropriateness of investigations, assessing the barriers to rational use, and developing and implementing an educational package for resident doctors.
Design:
Quality improvement study.
Setting:
Neonatal intensive care unit (NICU) from August, 2015 to December, 2016.
Participants:
All neonates admitted in NICU and resident doctors working in NICU.
Intervention:
Addressing barriers, educational package, posters and group discussions.
Main Outcome Measures:
Laboratory test rates for hematology, biochemistry and blood gas. Proportion of tests judged to be inappropriate.
Results:
At the baseline, median (IQR) laboratory test rate patient/day was 0.6 (0.2-1.5) and one-fifth of tests were classified as inappropriate. Mechanical ventilation and sepsis were independent predictors of laboratory test rates but could explain only 35% of the disparities, indicating variations in clinical practice. Following a short period of intervention, hematology investigations showed a trend towards reduction, though overall test rates did not change significantly.
Conclusion:
Addressing barriers, creating awareness and educational interventions were able to bring down hematology laboratory test rates in a short period. A longer period of sustained intervention is required to demonstrate significant effects on test ordering behavior.
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