Reducing Erythrocyte Sedimentation Rate Ordering: De-implementation and Diagnostic Stewardship.

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.