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Published on: May 13, 2021
Decreasing Herpes Simplex Virus (HSV) Testing Turnaround Time for Infants in a Hospital Setting: A Continuous Quality
Insights
Increasing herpes simplex virus (HSV) lab processing frequency significantly reduced test turnaround times (TAT) and length of stay (LOS) for febrile infants. This improvement in HSV diagnostics also led to a decrease in hospitalization costs.
Area of Science:
- Medical Diagnostics
- Infectious Disease Management
- Healthcare Operations
Background:
- Febrile infants often require hospitalization and antiviral treatment pending herpes simplex virus (HSV) diagnosis.
- Current diagnostic processes can lead to prolonged hospital stays and increased costs.
Purpose of the Study:
- To decrease length of stay (LOS), direct hospitalization costs, and lab turnaround time (TAT) for febrile infants by increasing HSV lab processing frequency.
Main Methods:
- Three Plan-Do-Study-Act (PDSA) cycles were implemented to incrementally increase HSV testing frequency.
- Data on patient LOS, TAT, and direct care costs were extracted from electronic medical records.
- Statistical analysis using Kruskal-Wallis and Dunn Tests compared outcomes between PDSA cycles.
Main Results:
- Turnaround time (TAT) for HSV testing decreased significantly, from over 30 hours to under 6 hours.
- Median length of stay (LOS) for febrile infants reduced from 2.4 to 1.9 days.
- Direct care costs saw a moderate decrease, from $4,348 to $4,164.
Conclusions:
- Increased HSV lab processing frequency effectively reduces TAT and LOS in febrile infants.
- While cost reductions were moderate, the improvements in diagnostic efficiency enhance patient care.
- Collaborative efforts between pediatric and pathology departments can optimize care for febrile infants nationwide.
Background:
Febrile infants require hospitalization and intravenous antiviral administration until providers rule out herpes simplex virus (HSV) infection. This study aimed to reduce the length of stay (LOS), direct hospitalization costs, and turnaround time (TAT) of lab results by increasing HSV lab processing frequency.
Methods:
The authors implemented three Plan-Do-Study-Act (PDSA) cycles to increase the frequency of HSV testing in the lab. PDSA 1 (2016-2017) increased processing frequency from three to five days per week (n = 61 patients). PDSA 2 (2018-2019) used the results from PDSA 1 to justify increasing processing frequency to seven days a week (n = 64 patients). PDSA 3 (2022-2023) rebuilt the coalition following staffing changes resulting from COVID-19 to ensure fidelity in daily processing (n = 72 patients). The research team extracted data on patient LOS, TAT, and direct care costs from the electronic medical record. Differences between PDSA cycles were assessed using Kruskal-Wallis and Dunn Tests.
Results:
TAT decreased from a median of 35.1 hours for cerebrospinal fluid and 30.5 hours for skin testing in the baseline period to 2.5 and 5.5 hours, respectively, in PDSA 3 (p < 0.001). LOS decreased from a median of 2.4 days in the baseline period to 1.9 days in PDSA 3 (p < 0.01). The direct cost of care decreased from a baseline median of $4,348 to $4,164 in PDSA 3 (p < 0.05).
Conclusion:
This study demonstrated a large reduction in TAT, with a moderate decrease in LOS and a more moderate impact on direct care costs with increased processing frequency. Other hospitals could use similar collaborations between pediatrics and pathology personnel to improve the quality of care in the treatment of febrile infants nationwide.
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