Reducing Laboratory Testing and Blood Draws in the Newborn Nursery to Increase High-value Care

Newborn infants undergo multiple blood tests before hospital discharge, some of which are unnecessary due to outdated hospital policies and provider variability. Reducing nonevidence-based laboratory testing can improve healthcare value, and clustering of blood sampling can reduce pain for newborns.

This quality improvement project aimed to reduce the weekly number of laboratory tests and blood draws per patient-day for newborns by 10% within 8 months. A multidisciplinary team developed and addressed key drivers with Plan-Do-Study-Act cycles. Interventions included high-value care education, implementation of the 2022 American Academy of Pediatrics hyperbilirubinemia clinical guidelines, and modification of the blood type and screen testing workflow. The balancing measures were to maintain the average length of stay less than 48 hours and a 7-day readmission rate less than 1.5%. Data were collected using electronic health record reports and analyzed with statistical process control charts.

The study included 7,749 newborn nursery patients during a 22-month period. Laboratory tests per patient-day decreased from 1.41 to 0.84 after implementation of the new American Academy of Pediatrics hyperbilirubinemia guidelines, and further decreased to 0.53 with changes to the type and screen workflow. The number of blood draws per patient-day decreased from 0.47 to 0.20 with implementation of the updated hyperbilirubinemia guidelines. Average length of stay increased from 47.4 to 50.7 hours, associated with unrelated hospital changes. Readmission rates were stable.

This quality improvement project exceeded the study goal, achieving a 62% reduction in laboratory tests and a 57% reduction in blood draws performed on newborns, thereby increasing value and decreasing pain without adverse effects.