Quality Improvement Methods Reduce Unnecessary Electrolyte Testing Without Compromising Care

Published April 4, 2018 | Pediatrics

Testing for electrolyte levels in hospitalized children is common, which makes sense given the essential role of electrolytes in healthy cell and organ function.

But is it possible to over-test? And at what cost—medical and financial—to patients, families, insurers, healthcare providers and hospitals?

Those questions formed the core of a study that demonstrated how electrolyte testing can be significantly reduced without compromising care.

Too often, the team found, lab tests are ordered without an expectation of abnormal results. That causes unnecessary pain from needle sticks and interruptions to patients’ sleep, possible anemia from excess blood loss, and potentially, a cascade of repeated testing after false-positives.

Researchers determined that the mean baseline rate was 2.0 lab draws per 10 patient days. Within one month, educational interventions helped reduce the rate by 35 percent. The project’s goal was 25 percent.

The team found no increase in resulting medical emergency team calls or readmission. The estimated annual savings in patient-level charges: $292,000.

“It is likely a similar approach could be used to assess other tests that may be over-performed,” says Patrick Brady, MD, MSc. “Importantly, this showed Cincinnati Children’s commitment to continuously improving the value of care we deliver.” The team also included researchers from the Heart Institute, the Anderson Center, and Johns Hopkins Hospital.

“I additionally was impressed by, and proud of, the fantastic energy and drive of our pediatric residents,” he says. “It gives me confidence that this next generation will be better stewards of our testing and increase the value of care. These issues were not talked about when I was in medical school, but they are now of profound importance to patients, families, and health systems.”