Rethinking Blood Testing in Pediatric Cancer Patients: A Quality Improvement Approach
Andrew M Grant1, Felicity A Wright1,2, Laura R M Chapman1
1Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney Children's Hospital's Network, Sydney, NSW, Australia.
Insights
Healthcare providers reduced daily blood tests in pediatric cancer patients by 37% through a quality improvement initiative. This strategy, focusing on clinician education and mindful ordering, decreased blood draws without causing patient harm.
Area of Science:
- Quality Improvement
- Healthcare Management
- Pediatric Oncology
Background:
- Overuse of blood tests strains healthcare resources and poses risks like infection and anemia.
- Pediatric cancer patients are especially vulnerable due to compromised immunity and limited blood volume.
- Daily blood testing was a common practice, necessitating intervention.
Purpose of the Study:
- To decrease the frequency of blood tests per bed day in an inpatient pediatric cancer unit by 15% within 8 months.
- To implement a sustainable strategy for reducing unnecessary blood draws.
Main Methods:
- A quality improvement project combined clinician education, collaborative guideline development, and behavioral change strategies.
- Clinicians were encouraged to "STOP and THINK" about the necessity of each blood test.
- Blood test frequency was compared before, during, and after the intervention from 2019-2021.
Main Results:
- The intervention achieved a 37% overall reduction in blood tests within 8 months.
- Liver Function Tests saw a significant 52% decrease in ordering frequency.
- Data included 26,941 blood tests across 1,558 admissions.
Conclusions:
- A multifaceted strategy integrating education and culture change effectively reduced blood test ordering frequency.
- The implemented changes led to significant blood test reduction without evidence of increased patient harm.
- This approach offers a model for optimizing diagnostic testing in vulnerable patient populations.
Introduction:
The overuse of blood tests burdens the healthcare system and can detrimentally impact patient care. Risks of frequent blood sampling include infection and clinician-induced anemia, which can negatively impact patients and their families. Pediatric cancer patients are particularly vulnerable as they are immunocompromised with a small blood volume. Four blood tests had become a daily practice. Therefore, we aimed to reduce the number of blood tests taken per bed day within the inpatient pediatric cancer unit by 15% within 8 months.
Methods:
This quality improvement project combined several strategies to reduce test frequency and empower clinicians on the rationale for blood test ordering. Recommendations were developed collaboratively presented in a summary table. Targeted behavior-change methodology built engagement and momentum for the change. All clinicians were challenged to STOP and THINK about why a test is necessary for each patient. The primary outcome measure was the frequency of the tests taken per bed day. Frequency was compared between pre- and postimplementation plus follow-up periods across 2019-2021.
Results:
26,941 blood tests were captured in 1,558 admissions. The intervention led to an overall blood test reduction of 37% over 8 months. Liver Function Tests were the standout, with a 52% decrease in test frequency.
Conclusions:
A strategy incorporating education and culture change, combined with clear guidance on testing frequency, significantly reduced the ordering frequency of blood tests without increased patient harm.
