Learning from Each Other: A Multisite Collaborative to Reduce Electrolyte Testing.

Area of Science:

• Pediatric hospital quality improvement
• Laboratory testing optimization
• Healthcare value enhancement

Background:

• Inpatient electrolyte testing rates vary significantly among pediatric hospitals.
• Providers face challenges in reducing unnecessary serum electrolyte laboratory testing.
• Unnecessary testing contributes to increased healthcare costs and potential patient harm.

Purpose of the Study:

• To reduce serum electrolyte testing among pediatric inpatients by 20% across five sites within six months.
• To evaluate the effectiveness of standardized interventions in a multisite quality improvement collaborative.
• To identify barriers and facilitators to reducing laboratory testing in a pediatric setting.

Main Methods:

• A national quality improvement collaborative implemented standardized interventions at five tertiary and quaternary children's hospitals.
• Interventions included cost card reminders, electronic medical record-based laboratory plans, structured rounds discussions, and education.
• The Plan-Do-Study-Act (PDSA) methodology was utilized, with weekly calls to discuss progress and barriers.

Main Results:

• The study included 17,149 patient-days across five hospitals.
• Baseline electrolyte testing rate was 4.82 tests per 10 patient-days.
• Postimplementation, the testing rate decreased to 4.19 tests per 10 patient-days, a 13% reduction.
• Significant variation in baseline testing rates and intervention effectiveness was observed between hospitals.

Conclusions:

• A multisite quality improvement collaborative successfully reduced inpatient electrolyte testing.
• The 20% reduction goal was not met across all sites, indicating challenges in widespread implementation.
• Quality improvement collaboratives must account for contextual variations when adapting interventions across diverse healthcare settings.