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Reducing Electrolyte Testing in Hospitalized Children by Using Quality Improvement Methods.

ABSTRACT: BACKGROUND AND OBJECTIVES:Despite studies indicating a high rate of overuse, electrolyte testing remains common in pediatric inpatient care. Frequently repeated electrolyte tests often return normal results and can lead to patient harm and increased cost. We aimed to reduce electrolyte testing within a hospital medicine service by >25% within 6 months. METHODS:We conducted an improvement project in which we targeted 6 hospital medicine teams at a large academic children's hospital system by using the Model for Improvement. Interventions included standardizing communication about the electrolyte testing plan and education about the costs and risks associated with overuse of electrolyte testing. Our primary outcome measure was the number of electrolyte tests per patient day. Secondary measures included testing charges and usage rates of specific high-charge panels. We tracked medical emergency team calls and readmission rates as balancing measures. RESULTS:The mean baseline rate of electrolyte testing was 2.0 laboratory draws per 10 patient days, and this rate decreased by 35% after 1 month of initial educational interventions to 1.3 electrolyte laboratory draws per 10 patient days. This change has been sustained for 9 months and could save an estimated $292?000 in patient-level charges over the course of a year. Use of our highest-charge electrolyte panel decreased from 67% to 22% of testing. No change in rates of medical emergency team calls or readmission were found. CONCLUSIONS:Our improvement intervention was associated with significant and rapid reduction in electrolyte testing and has not been associated with unintended adverse events.

SUBMITTER: Tchou MJ

PROVIDER: S-EPMC7008632 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Reducing Electrolyte Testing in Hospitalized Children by Using Quality Improvement Methods.

Tchou Michael J MJ Tang Girdwood Sonya S Wormser Benjamin B Poole Meifawn M Davis-Rodriguez Stephanie S Caldwell J Timothy JT Shannon Lauren L Hagedorn Philip A PA Biondi Eric E Simmons Jeffrey J Anderson Jeffrey J Brady Patrick W PW

Pediatrics 20180404 5

<h4>Background and objectives</h4>Despite studies indicating a high rate of overuse, electrolyte testing remains common in pediatric inpatient care. Frequently repeated electrolyte tests often return normal results and can lead to patient harm and increased cost. We aimed to reduce electrolyte testing within a hospital medicine service by >25% within 6 months.<h4>Methods</h4>We conducted an improvement project in which we targeted 6 hospital medicine teams at a large academic children's hospital ...[more]

PMID: 29618583

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Project description:Contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity and mortality after percutaneous coronary interventions and is a patient safety objective of the National Quality Forum. However, no formal quality improvement program to prevent CI-AKI has been conducted. Therefore, we sought to determine whether a 6-year regional multicenter quality improvement intervention could reduce CI-AKI after percutaneous coronary interventions.We conducted a prospective multicenter quality improvement study to prevent CI-AKI (serum creatinine increase ?0.3 mg/dL within 48 hours or ?50% during hospitalization) among 21 067 nonemergent patients undergoing percutaneous coronary interventions at 10 hospitals between 2007 and 2012. Six intervention hospitals participated in the quality improvement intervention. Two hospitals with significantly lower baseline rates of CI-AKI, which served as benchmark sites and were used to develop the intervention, and 2 hospitals not receiving the intervention were used as controls. Using time series analysis and multilevel poisson regression clustering to the hospital level, we calculated adjusted risk ratios for CI-AKI comparing the intervention period to baseline. Adjusted rates of CI-AKI were significantly reduced in hospitals receiving the intervention by 21% (risk ratio, 0.79; 95% confidence interval: 0.67-0.93; P=0.005) for all patients and by 28% in patients with baseline estimated glomerular filtration rate <60 mL/min per 1.73 m(2) (risk ratio, 0.72; 95% confidence interval: 0.56-0.91; P=0.007). Benchmark hospitals had no significant changes in CI-AKI. Key qualitative system factors associated with improvement included multidisciplinary teams, limiting contrast volume, standardized fluid orders, intravenous fluid bolus, and patient education about oral hydration.Simple cost-effective quality improvement interventions can prevent ?1 in 5 CI-AKI events in patients with undergoing nonemergent percutaneous coronary interventions.

Project description:Background/objectivesTo describe the Mobility Action Group (MACT), an innovative process to enhance implementation of hospital mobility programs and create a culture of mobility in acute care.DesignContinuous quality improvement intervention with episodic data review.SettingInpatient units including medical, surgical, and intensive care settings.ParticipantsA total of 42 hospitals of varying sizes across the United States.InterventionsThe MACT and Change Package were developed to provide a conceptual framework, road map, and step-by-step guide to enable mobility teams to implement mobility programs successfully and meet their mobilization goals. Participants were encouraged to select two to three change tactics to pursue during the first action cycle and select and implement additional tactics in subsequent cycles. Nine learning sessions were held via webinar from April 27, 2017, to October 5, 2017, during which faculty provided brief presentations, facilitation, and group discussion.MeasurementsImplementation of programs, walks per day, use of bed and chair alarms, and participant satisfaction.ResultsSuccessful implementation of mobility programs was achieved at most (76%) sites. The proportion of patients who received at least three walks per day increased from 9% to 19%. The proportion of patients who were placed on a bed or chair alarm decreased from 36% to 20%. On average, 69% of participants reported they were "strongly satisfied" with the learning sessions. Most participants found the Change Package (58%) and Toolkit (63%) "very helpful." Since the conclusion of the active initiative, the Change Package has been downloaded 1,200 times. Of those who downloaded it, 48% utilized it to establish a mobility program, and 58% used it at their organization at least once a month.ConclusionThe MACT and Change Package provides an innovative approach emphasizing systemwide change that can help catalyze a culture of mobility in hospitals across the nation, improving the quality of care for hospitalized older adults. J Am Geriatr Soc 68:2373-2381, 2020.

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Reducing Electrolyte Testing in Hospitalized Children by Using Quality Improvement Methods.

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Reducing Electrolyte Testing in Hospitalized Children by Using Quality Improvement Methods.

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