Improving the Timing of Laboratory Studies in Hospitalized Children: A Quality Improvement Study

Abstract

OBJECTIVES For hospitalized children and their families, laboratory study collection at night and in the early morning interrupts sleep and increases the stress of a hospitalization. To change this practice, our quality improvement (QI) study developed a rounding checklist aimed at increasing the percentage of routine laboratory studies ordered for and collected after 7 am. METHODS Our QI study was conducted on the pediatric hospital medicine service at a single-site urban children’s hospital over 28 months. Medical records from 420 randomly selected pediatric inpatients were abstracted, and 5 plan-do-study-act cycles were implemented during the intervention. Outcome measures included the percentage of routine laboratory studies ordered for and collected after 7 am. The process measure was use of the rounding checklist. Run charts were used for analysis. RESULTS The percentage of laboratory studies ordered for after 7 am increased from a baseline median of 25.8% to a postintervention median of 75.0%, exceeding our goal of 50% and revealing special cause variation. In addition, the percentage of laboratory studies collected after 7 am increased from a baseline median of 37.1% to 76.4% post intervention, with special cause variation observed. CONCLUSIONS By implementing a rounding checklist, our QI study successfully increased the percentage of laboratory studies ordered for and collected after 7 am and could serve as a model for other health care systems to impact provider ordering practices and behavior. In future initiatives, investigators should evaluate the effects of similar interventions on caregiver and provider perceptions of patient- and family-centeredness, satisfaction, and the quality of patient care.

Promoting a Sleep-friendly Environment by Minimizing Overnight Room Entries

“…Others have conducted QI interventions intending to minimize unnecessary disruptions to sleep. 7,10,[13][14][15] Cooke et al, 7 Lee et al, 13 and Lin et al 14 similarly targeted overnight vital sign orders; however, Cooke et al only targeted blood pressure, while Lee et al targeted blood pressure and temperature measurement (in addition to laboratory collection timing). Lin et al limited the study population to pediatric patients hospitalized with failure to thrive or hyperbilirubinemia.…”

“…Mozer et al 10 targeted medication administration times but limited the intervention to 4 oral antibiotics. Like our intervention, Ramazani et al 15 also used a rounding checklist but targeted only laboratory collection timing. These studies tracked order changes or subjective measures of sleep disruption (caregiver report) as their outcome measures.…”

Increasing COVID-19 Immunization Rates through a Vaccination Program for Hospitalized Children

“…A column was added to the shared attending patient list in the EHR with the patient’s last documented COVID-19 vaccine administration date. Building upon previous quality improvement work at our institution that standardized a rounding checklist for attending physicians, 18 the “LEAD” acronym (intravenous Lines, Expiring orders, Antimicrobials, and Diagnostic testing) was adapted to “I LEAD,” adding “Immunizations” with a specific reference to COVID-19 and influenza vaccines for eligible patients. This checklist auto-populated into a templated attending progress note attestation.…”

Timing of blood draws among hospitalized patients: An evaluation of the electronic health records from a large health care system

“…During morning rounds, clinical teams often deem it necessary to have laboratory results available to assess patients' most recent health status. Although some studies have shown that avoiding performing blood draws in the early morning is a feasible strategy and may result in increased patient satisfaction, 9,10,14,15 larger studies are needed to assess if doing so has untoward effects on quality of care or length of stay.…”