Reducing Unnecessary Respiratory Viral Testing to Promote High-Value Care

Area of Science:

• Pediatrics
• Infectious Diseases
• Healthcare Improvement

Background:

• Viral respiratory infections are common in children, often not requiring specific testing.
• Current practice frequently involves uncomfortable nasopharyngeal swabs for viral testing, despite guidelines against routine use.
• Existing testing protocols often yield results that do not alter patient care.

Purpose of the Study:

• To reduce unnecessary respiratory viral testing (RVT) in pediatric emergency departments (ED) by 50%.
• To decrease RVT on pediatric medicine wards (PMWs) by 25% over a 36-month period.
• To implement and sustain a standardized RVT pathway.

Main Methods:

• Formulated an RVT pathway using plan-do-study-act cycles and expert review.
• Employed a multifaceted strategy including improved testing, electronic order modifications, audit/feedback, and education.
• Utilized statistical process control charts to monitor RVT rates in the ED and PMWs.

Main Results:

• Achieved a sustained decrease in RVT from 3.0% to 0.5% of ED visits.
• Reduced RVT on PMWs from 44.3 to 30.1 per 1000 patient days.
• Demonstrated a 50% reduction in overall ED RVT, even with a new rapid influenza test, without adverse effects on return visits or nosocomial infections.

Conclusions:

• A standardized, electronically integrated RVT pathway effectively reduced unnecessary testing in pediatric settings.
• Sustained reduction was supported by audit/feedback, reminders, and ongoing education.
• The initiative successfully decreased testing without compromising patient safety or outcomes.