Reducing Unnecessary Testing in Uncomplicated Skin and Soft Tissue Infections: A Quality Improvement Approach

Area of Science:

• Pediatric Hospital Medicine
• Quality Improvement Science
• Infectious Diseases

Background:

• Skin and soft tissue infections (SSTIs) are common pediatric diagnoses with significant healthcare costs.
• Evidence suggests that laboratory tests like blood cultures, complete blood cell counts, erythrocyte sedimentation rate, and C-reactive protein offer limited value in managing uncomplicated SSTIs (uSSTIs).
• Reducing unnecessary laboratory utilization is crucial for optimizing pediatric healthcare resource allocation and patient management.

Purpose of the Study:

• To decrease the number of laboratory tests ordered for pediatric patients with uSSTIs admitted to a hospital medicine service.
• To achieve a 25% reduction in laboratory tests per patient encounter within three months.
• To implement and evaluate a quality improvement initiative targeting diagnostic test utilization.

Main Methods:

• An interdisciplinary team spearheaded a quality improvement (QI) project, including a literature review and analysis of 12 months of medical records.
• Key drivers identified by stakeholders led to the creation of an electronic order set and a collaborative QI project between pediatric hospital medicine and emergency departments.
• The primary outcome was the mean number of laboratory tests per patient encounter, with unplanned readmissions and missed diagnoses monitored as balancing measures.

Main Results:

• The rate of laboratory tests per patient encounter decreased by 35%, from a baseline of 3.4 to 2.2 tests, exceeding the 25% reduction goal.
• This reduction was sustained for 14 months post-intervention, with order set adherence rates of 80% during the intervention and 87% post-intervention.
• No unplanned readmissions or missed diagnoses were observed during the study period, indicating patient safety was maintained.

Conclusions:

• The interdisciplinary team successfully reduced unnecessary laboratory testing in pediatric uSSTI patients without compromising patient safety.
• Key factors contributing to success included fostering local awareness, developing standardized electronic order sets, defining clear patient selection criteria, and implementing a collaborative QI framework.
• This project demonstrates the effectiveness of targeted QI interventions in optimizing diagnostic test utilization in pediatric inpatient settings.