Diagnostic Testing During Pediatric Hospitalizations: The Role of Attending In-House Coverage and Daytime Exposure

Area of Science:

• Pediatric hospital medicine
• Health services research
• Medical quality improvement

Background:

• Overutilization of diagnostic tests is a significant concern in pediatric academic medical centers.
• Understanding factors influencing test utilization is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To assess variations in diagnostic test utilization based on the proportion of hospitalization occurring during daytime versus nighttime hours.
• To examine the association between attending physician in-house coverage on teaching services and test utilization for hospitalized pediatric patients.

Main Methods:

• Analysis of electronic health record data from 11,567 pediatric hospitalizations at a large academic medical center.
• Inclusion of laboratory and imaging test orders, ordering physician information, and order timing.
• Cross-sectional effect modification analysis to estimate the impact of attending physician coverage on test utilization.

Main Results:

• Admission to a teaching service was independently associated with increased utilization of laboratory and imaging tests.
• A 10% increase in daytime hospitalization on teaching services correlated with a decrease of 0.76 test orders, attributed to direct attending supervision.
• Overnight attending physician care was associated with slightly reduced diagnostic test utilization.

Conclusions:

• Direct attending physician involvement during nighttime hours in pediatric hospitalizations may lead to more judicious use of diagnostic tests.
• Findings suggest that the timing and nature of attending supervision influence diagnostic test ordering patterns in pediatric academic settings.