Coe Megan, Gruhler Heidi, Schefft Matthew, Williford Dustin, Burger Barrett, Crain Emily, Mihalek Alexandra J, Santos Maria, Cotter Jillian M, Trowbridge Gregory, Kessenich Jeri, Nolan Mark, Tchou Michael J
Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
Children's Hospital Association, Lenexa, Kansas.
Pediatr Qual Saf. 2020 Oct 26;5(6):e351. doi: 10.1097/pq9.0000000000000351. eCollection 2020 Nov-Dec.
Inpatient electrolyte testing rates vary significantly across pediatric hospitals. Despite evidence that unnecessary testing exists, providers still struggle with reducing electrolyte laboratory testing. We aimed to reduce serum electrolyte testing among pediatric inpatients by 20% across 5 sites within 6 months.
A national quality improvement collaborative evaluated standardized interventions for reducing inpatient serum electrolyte testing at 5 large tertiary and quaternary children's hospitals. The outcome measure was the rate of electrolyte laboratory tests per 10 patient-days. The interventions were adapted from a previous single-site improvement project and included cost card reminders, automated laboratory plans via electronic medical record, structured rounds discussions, and continued education. The collaborative utilized weekly conference calls to discuss Plan, Do, Study, Act cycles, and barriers to implementation efforts.
The study included 17,149 patient-days across 5 hospitals. The baseline preintervention electrolyte laboratory testing rate mean was 4.82 laboratory tests per 10 patient-days. Postimplementation, special cause variation in testing rates shifted the mean to 4.19 laboratory tests per 10 patient-days, a 13% reduction. There was a wide variation in preintervention electrolyte testing rates and the effectiveness of interventions between the hospitals participating in the collaborative.
This multisite improvement collaborative was able to rapidly disseminate and implement value improvement interventions leading to a reduction in electrolyte testing; however, we did not meet our goal of 20% testing reduction across all sites. Quality improvement collaboratives must consider variation in context when adapting previously successful single-center interventions to a wide variety of sites.
儿科医院的住院患者电解质检测率差异显著。尽管有证据表明存在不必要的检测，但医疗服务提供者在减少电解质实验室检测方面仍面临困难。我们旨在在6个月内将5个地点的儿科住院患者血清电解质检测减少20%。
一项全国性质量改进协作项目评估了5家大型三级和四级儿童医院减少住院患者血清电解质检测的标准化干预措施。结果指标是每10个患者日的电解质实验室检测率。这些干预措施改编自之前的一个单中心改进项目，包括成本卡提醒、通过电子病历实现的自动化实验室计划、结构化查房讨论以及继续教育。该协作项目利用每周的电话会议来讨论计划、执行、研究、行动循环以及实施工作的障碍。
该研究涵盖了5家医院的17149个患者日。干预前电解质实验室检测率的基线平均值为每10个患者日4.82次实验室检测。实施后，检测率的特殊原因变异使平均值降至每10个患者日4.19次实验室检测，降低了13%。参与协作的医院之间，干预前的电解质检测率以及干预效果存在很大差异。
这个多地点改进协作项目能够迅速传播并实施价值改进干预措施，从而减少了电解质检测；然而，我们并未实现所有地点检测减少20%的目标。在将之前成功的单中心干预措施应用于各种不同地点时，质量改进协作项目必须考虑背景差异。
