Improving the Timing of Laboratory Studies in Hospitalized Children: A Quality Improvement Study
Suzanne N Ramazani1, Julie Albright Gottfried2, Maha Kaissi2
1Department of Pediatrics, Golisano Children's Hospital suzanne_ramazani@urmc.rochester.edu.
Insights
A quality improvement study used a rounding checklist to increase nighttime laboratory study collection in hospitalized children. This initiative successfully shifted routine lab orders and collections to after 7 am, improving patient rest.
Area of Science:
- Pediatric Hospital Medicine
- Quality Improvement Science
- Healthcare Operations
Background:
- Nocturnal laboratory study collection disrupts sleep and increases stress for hospitalized children and their families.
- Current practices often lead to routine laboratory tests being ordered and collected during early morning hours, impacting patient rest.
Purpose of the Study:
- To implement a quality improvement initiative using a rounding checklist to increase the percentage of routine laboratory studies ordered and collected after 7 am.
- To reduce sleep disruption and hospitalization stress for pediatric patients through optimized laboratory testing schedules.
Main Methods:
- A 28-month quality improvement study was conducted on a pediatric hospital medicine service.
- Five plan-do-study-act cycles were implemented, utilizing a rounding checklist intervention.
- Medical records of 420 pediatric inpatients were analyzed, with run charts used for outcome assessment.
Main Results:
- The percentage of routine laboratory studies ordered for after 7 am increased from a baseline median of 25.8% to 75.0%.
- The percentage of routine laboratory studies collected after 7 am rose from a baseline median of 37.1% to 76.4%.
- Both outcomes demonstrated special cause variation, indicating a significant intervention effect.
Conclusions:
- Implementation of a rounding checklist effectively increased the ordering and collection of routine laboratory studies after 7 am.
- This quality improvement model can be adopted by other healthcare systems to modify provider ordering behaviors.
- Future research should explore the impact of such interventions on patient- and family-centered care perceptions and satisfaction.
Objectives:
For hospitalized children and their families, laboratory study collection at night and in the early morning interrupts sleep and increases the stress of a hospitalization. To change this practice, our quality improvement (QI) study developed a rounding checklist aimed at increasing the percentage of routine laboratory studies ordered for and collected after 7 am.
Methods:
Our QI study was conducted on the pediatric hospital medicine service at a single-site urban children's hospital over 28 months. Medical records from 420 randomly selected pediatric inpatients were abstracted, and 5 plan-do-study-act cycles were implemented during the intervention. Outcome measures included the percentage of routine laboratory studies ordered for and collected after 7 am. The process measure was use of the rounding checklist. Run charts were used for analysis.
Results:
The percentage of laboratory studies ordered for after 7 am increased from a baseline median of 25.8% to a postintervention median of 75.0%, exceeding our goal of 50% and revealing special cause variation. In addition, the percentage of laboratory studies collected after 7 am increased from a baseline median of 37.1% to 76.4% post intervention, with special cause variation observed.
Conclusions:
By implementing a rounding checklist, our QI study successfully increased the percentage of laboratory studies ordered for and collected after 7 am and could serve as a model for other health care systems to impact provider ordering practices and behavior. In future initiatives, investigators should evaluate the effects of similar interventions on caregiver and provider perceptions of patient- and family-centeredness, satisfaction, and the quality of patient care.
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