A Quality Improvement Initiative to Reduce Duplicate Inflammatory Marker Use.

Area of Science:

• Clinical Medicine
• Quality Improvement Science
• Pediatric Hospital Medicine

Background:

• Multiple inflammatory markers (IMs) are frequently ordered together, despite a lack of evidence supporting clinical benefit.
• Unnecessary laboratory testing increases healthcare costs and may lead to patient harm.

Purpose of the Study:

• To reduce the number of duplicate inflammatory marker tests ordered for pediatric patients by 10% within 12 months.
• To evaluate the impact of a quality improvement initiative on IM ordering practices.

Main Methods:

• A quality improvement project using the model for improvement methodology was implemented on a pediatric hospital medicine service.
• Interventions included provider education, integration into physician incentive plans, and review of disease-specific pathways.
• Primary outcome: reduction in "duplicate IM use" (≥2 IMs within 24 hours); Secondary outcome: reduction in any IM use; Balancing measures: complete blood count use, length of stay, readmission rate.

Main Results:

• Baseline duplicate IM use was 43%, decreasing to 12% post-intervention.
• Overall IM use decreased from 19% to 12%.
• Balancing measures, including length of stay and readmission rates, remained stable, and complete blood count use showed no clear correlation.

Conclusions:

• The quality improvement project effectively reduced duplicate and overall inflammatory marker testing in pediatric inpatients.
• These reductions were achieved without adverse effects on key patient safety and care metrics.
• Safe de-escalation of inflammatory marker testing is achievable in pediatric hospital settings.