Project RedDE: Cluster Randomized Trial to Reduce Missed or Delayed Abnormal Laboratory Value Actions

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Laboratory Medicine

Background:

• Failure to follow up on abnormal laboratory results is a common issue that can harm patients.
• This study aimed to assess if a quality improvement collaborative (QIC) could decrease missed or delayed actions on abnormal lab values.

Purpose of the Study:

• To evaluate the effectiveness of a quality improvement collaborative (QIC) intervention in reducing errors in the follow-up of abnormal laboratory values within pediatric practices.

Main Methods:

• A national cohort of pediatric practices was cluster-randomized to a QIC intervention.
• The intervention included video conferences, data sharing, QI coaching, and specific tools.
• Generalized mixed-effects regression models were used to compare appropriate provider actions on abnormal laboratory values between control and intervention phases.

Main Results:

• The QIC intervention did not significantly change the percentage of patients receiving appropriate actions during the initial 8-month phase (Risk Difference [RD] 1%; 95% Confidence Interval [CI] -1%, 3%).
• Post-hoc analyses revealed significant improvements in later phases: control vs. sustain phase (RD 3%; 95% CI 0.3%, 6%) and control vs. maintenance phase (RD 6%; 95% CI 3%, 9%).

Conclusions:

• The quality improvement collaborative (QIC) did not reduce abnormal laboratory errors during the initial intervention period.
• Significant reductions in errors were observed when comparing the sustain and maintenance phases (9-24 months) to the control phase, indicating long-term benefits.