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Area of Science:

  • Clinical Laboratory Science
  • Healthcare Quality Improvement
  • Pediatric Medicine

Background:

  • The Choosing Wisely campaign advises against routine erythrocyte sedimentation rate (ESR) use for acute inflammation/infection assessment.
  • A children's hospital observed high concurrent ordering of ESR and C-reactive protein (CRP).
  • An initiative was launched to decrease ESR testing rates by 20% within six months.

Purpose of the Study:

  • To reduce the utilization of erythrocyte sedimentation rate (ESR) testing in pediatric inpatient and emergency departments.
  • To evaluate the effectiveness of Lean process improvement, provider education, and clinical decision support in modifying laboratory ordering practices.

Main Methods:

  • Lean principles were applied to identify root causes of ESR ordering.
  • Interventions included provider education and electronic health record order panel implementation.
  • Monthly ESR testing rates per 1000 patient days/ED visits were tracked using statistical process control.

Main Results:

  • ESR testing rates decreased by 22% (inpatient) and 40% (emergency department).
  • These reductions were sustained for over one year, including during the COVID-19 pandemic.
  • C-reactive protein (CRP) testing rates remained stable, indicating a shift in diagnostic strategy rather than reduced testing.

Conclusions:

  • Provider education and clinical decision support effectively reduced unnecessary erythrocyte sedimentation rate (ESR) ordering.
  • The interventions demonstrated sustained impact on laboratory utilization in pediatric care settings.