Quality Improvement Initiative to Reduce Inappropriate Viral Testing within the Pediatric Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Clinical Diagnostics
• Quality Improvement Initiatives

Background:

• The American Academy of Pediatrics recommends against comprehensive viral panel testing for pediatric respiratory illnesses.
• A pediatric emergency department (PED) previously ordered comprehensive respiratory pathogen panels (RPPs) in 11.9% of visits, with 50% lacking clinical indication.
• This highlights a need to optimize viral testing practices in pediatric emergency settings.

Purpose of the Study:

• To decrease the utilization of RPPs in a PED from 11.9% to 9% during the respiratory season.
• To align testing practices with Choosing Wisely recommendations.
• To improve the efficiency and cost-effectiveness of viral diagnostics in pediatric care.

Main Methods:

• Implemented a quality improvement project using four interventions over two plan-do-study-act cycles.
• Key interventions included developing clinical guidelines, provider education, introducing a narrower Quad PCR panel (influenza A/B, COVID-19, RSV), and implementing order-entry requirements for RPPs.
• Data were tracked via a clinical dashboard and chart reviews.

Main Results:

• The percentage of PED visits with RPP orders decreased from 11.9% at baseline to 6.8% during the intervention period.
• This reduction was sustained in the subsequent respiratory season.
• The initiative resulted in annual cost savings exceeding $300,000 without increasing the use of alternative viral tests.

Conclusions:

• This quality improvement initiative effectively reduced comprehensive viral PCR testing in the PED.
• The changes in practice were sustained long-term.
• The project demonstrated that optimizing viral testing protocols can lead to significant cost savings and improved resource allocation without compromising patient care.