Reducing Unnecessary Medical Screening for Pediatric Psychiatric Admissions in the Emergency Department: A Quality...

This quality improvement initiative aimed to increase adherence to the Choosing Wisely recommendation by increasing compliance with medical screening recommendations for pediatric patients undergoing psychiatric evaluation in the emergency department (ED) from 70% to 95% between October 2024 and August 2025, thereby reducing unnecessary screening.

We conducted an observational study with sequential interventions in an urban tertiary care pediatric ED. Eligible patients were those with a psychiatry consult order. Laboratory testing was considered clinically indicated if documented by the physician. Interventions included operational changes, staff education, and monthly feedback. The primary outcome was compliance with indication-based testing (either no testing or testing with documented indication). Process measures included compliance among discharged and admitted patients; the balancing measure was missed diagnoses. Data were collected via chart review and analyzed using p-charts.

Among 756 encounters, 216 required inpatient psychiatric admission. Before implementation, all admitted patients received screening laboratory tests. After implementation, 50 of 101 admitted patients (50%) had no laboratory testing. Overall compliance improved from 71.4% to 96.3%, with discharged patients increasing from 80.1% to 100% and admitted patients increasing from 42.9% to 85.6%. No patients required transfer back to medical services for missed diagnoses or complications.

Implementing Choosing Wisely recommendations was associated with a significant increase in compliance and reduction in unnecessary screening without compromising safety. Findings support indication-based medical clearance, improving efficiency, reducing costs, and aligning ED practice with evidence-based standards.

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.