An Initiative to Decrease Laboratory Testing in a NICU

Area of Science:

• Neonatal Intensive Care Unit (NICU) Quality Improvement
• Clinical Laboratory Science
• Pediatric Healthcare Management

Background:

• Frequent laboratory testing in the NICU can lead to increased costs, blood loss, and pain.
• These factors may negatively impact infant growth and neurodevelopmental outcomes.
• A 20% reduction in routine laboratory testing was targeted over 24 months.

Purpose of the Study:

• To implement a quality improvement project aimed at reducing routine laboratory testing in a NICU.
• To decrease the number of laboratory tests performed per 1000 patient days by 20% within a 24-month timeframe.
• To assess the impact on secondary outcomes including blood volume, costs, and patient safety.

Main Methods:

• A multifaceted quality improvement project utilizing the Institute for Healthcare Improvement's Model for Improvement.
• Baseline data analysis to prioritize interventions, including guideline development and EMR optimization.
• Primary outcome: laboratory tests per 1000 patient days; Secondary outcomes: blood glucose, bilirubin, blood volume, cost; Balancing measure: extreme laboratory values.

Main Results:

• Achieved a 26.8% reduction in laboratory tests per 1000 patient days (approximately 51,000 fewer tests).
• Significant decreases observed in secondary measures: nearly 8 liters of blood saved and $258,000 cost savings.
• Reductions were sustained for at least 7 months post-intervention, with no adverse events linked to the changes.

Conclusions:

• Multifaceted interventions, including guideline development and technology optimization, effectively reduced NICU laboratory testing.
• The project demonstrated a significant and sustained decrease in testing volume, blood draw volume, and associated costs.
• The implemented strategies proved safe and effective, leading to sustained improvements without compromising patient safety.