A Quality Improvement Initiative to Reduce Duplicate Inflammatory Marker Use

Inflammatory markers (IMs) are often ordered in multiples, even though evidence suggests that this does not add any clinical benefit. The project aimed to reduce the number of duplicate IMs for patients by 10% in 12 months.

We implemented a quality improvement (QI) project at our hospital, focusing on patients admitted to the pediatric hospital medicine service. The team chose the model for improvement as the QI methodology. Key interventions included ongoing provider education, integrating the project into the physician incentive plan, and reviewing disease-specific pathways. The primary outcome measure was "duplicate IM use," which was defined as any two or more IMs (procalcitonin, C-reactive protein, or erythrocyte sedimentation rate) obtained on the same patient within 24 hours. The secondary outcome measure was any IM use during their stay, and the balancing measures were average complete blood count use, hospital length of stay, and 7-day readmission rate.

The baseline duplicate IM use, and any IM use was 43% and 19%, respectively. After the start of this QI project, duplicate IM use decreased to 12%, and the use of any IM also decreased to 12%. Complete blood count use varied from 11% to 24% during the project without obvious correlation to IM use. Hospital length of stay decreased from 2.5 to 2.6 days, and the 7-day readmission rate remained at 2.8%.

The duplicate IM use and IM use were decreased without a concurrent increase in the balancing measures, indicating that a safe reduction of IM testing is feasible in inpatient pediatric care.