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Patterns of Electrolyte Testing at Children's Hospitals for Common Inpatient Diagnoses
Michael J Tchou1,2, Matt Hall3, Samir S Shah4,2
1Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; michael.tchou@childrenscolorado.org.
Insights
Hospital electrolyte testing rates vary widely in children. Consistent testing patterns across diagnoses suggest institutional culture influences overuse, highlighting potential for waste reduction.
Area of Science:
- Pediatric Health Services Research
- Health Care Quality Improvement
- Clinical Laboratory Utilization
Background:
- Laboratory test overuse leads to healthcare waste, increased resource use, and patient harm.
- Understanding hospital-level testing variations can identify outliers and reduce waste.
- Electrolyte testing is a common laboratory test with potential for overuse.
Purpose of the Study:
- To analyze variations in hospital-level electrolyte testing rates across common pediatric inpatient diagnoses.
- To determine if hospital-level testing patterns for one diagnosis correlate with patterns for other diagnoses.
- To identify factors influencing electrolyte testing decisions in children's hospitals.
Main Methods:
- Retrospective cohort study of 497,719 pediatric inpatient encounters across 41 children's hospitals (2010-2016).
- Defined initial electrolyte testing (within 2 days) and repeat testing (subsequent within encounter).
- Compared risk-adjusted testing rates for gastroenteritis against other diagnoses; used linear regression to assess correlations.
Main Results:
- Significant variation observed in adjusted initial and repeat electrolyte testing rates across hospitals.
- Hospital testing rates for gastroenteritis moderately to strongly correlated with other diagnoses (initial r=0.63, repeat r=0.83).
- Higher initial testing rates correlated with increased repeat testing for most diagnoses, except gastroenteritis.
Conclusions:
- Wide variation exists in pediatric inpatient electrolyte testing rates across diagnoses and hospitals.
- Hospital-level testing rates show consistency across multiple diagnoses, suggesting influence of institutional factors like culture.
- Findings indicate potential for targeted interventions to reduce unnecessary electrolyte testing and associated healthcare waste.
Background:
Overuse of laboratory testing contributes substantially to health care waste, downstream resource use, and patient harm. Understanding patterns of variation in hospital-level testing across common inpatient diagnoses could identify outliers and inform waste-reduction efforts.
Methods:
We conducted a multicenter retrospective cohort study of pediatric inpatients at 41 children's hospitals using administrative data from 2010 to 2016. Initial electrolyte testing was defined as testing occurring within the first 2 days of an encounter, and repeat testing was defined as subsequent testing within an encounter in which initial testing occurred. To examine if testing rates correlated across diagnoses at the hospital level, we compared risk-adjusted rates for gastroenteritis with a weighted average of risk-adjusted rates in other diagnosis cohorts. For each diagnosis, linear regression was performed to compare initial and subsequent testing.
Results:
In 497 719 patient encounters, wide variation was observed across hospitals in adjusted, initial, and repeat testing rates. Hospital-specific rates of testing in gastroenteritis were moderately to strongly correlated with the weighted average of testing in other conditions (initial: r = 0.63; repeat r = 0.83). Within diagnoses, higher hospital-level initial testing rates were associated with significantly increased rates of subsequent testing for all diagnoses except gastroenteritis.
Conclusions:
Among children's hospitals, rates of initial and repeat electrolyte testing vary widely across 8 common inpatient diagnoses. For most diagnoses, hospital-level rates of initial testing were associated with rates of subsequent testing. Consistent rates of testing across multiple diagnoses suggest that hospital-level factors, such as institutional culture, may influence decisions for electrolyte testing.