Reducing Unnecessary Postoperative Complete Blood Count Testing in the Pediatric Intensive Care Unit

Abstract

Context: Complete blood count (CBC) testing commonly occurs to determine the need for blood transfusions after surgical procedures. Many clinicians believe postoperative CBCs are "routine."Objective: To decrease unnecessary routine CBC testing in a low-risk cohort of postoperative patients in the pediatric intensive care unit (PICU) at The Children's Hospital of Philadelphia by 50% in 6 months.Design: Quality-improvement study. Data from our institution regarding frequency of ordering laboratory studies and transfusion requirements were collected for prior qualityimprovement work demonstrating the safety and feasibility of avoiding routine postoperative CBCs in this cohort. Baseline survey data were gathered from key stakeholders on attitudes about and utilization of routine postoperative laboratory testing. Patient and clinician data were shared with all PICU clinicians. Simple Plan-Do-Study-Act cycles involving education, audit, and feedback were put into place.Main Outcome Measures: Percentage of postoperative patients receiving CBCs within 48 hours of PICU admission. Balancing measures were hemoglobin level below 8 g/dL in patients for whom CBCs were sent and blood transfusions up to 7 days postoperatively for any patients in this cohort.Results: Sustained decreases below our 50% goal were seen after our interventions. There were no hemoglobin results below 8 g/dL or surgery-related blood transfusions in this cohort within 7 days of surgery. Estimated hospital charges related to routine postoperative CBCs decreased by 87% during 6 postintervention months.Conclusion: A simple approach to a systemic problem in the PICU of unnecessary laboratory testing is feasible and effective. By using local historical data, we were able to identify a cohort of patients for whom routine postoperative CBC testing is unnecessary.

The Cost-Effectiveness of Requesting a Complete Blood Count (CBC) in the Management of COVID-19 in Saudi Arabia

“…However, cost-effectiveness studies focused entirely on CBC are lacking. A database search of PubMed for studies on the cost-effectiveness of CBC yielded a single study [ 20 ], and Google Scholar yielded only two studies [ 21 , 22 ] and a Master’s thesis [ 23 ]. Such a lack of studies makes this study the first of its kind to assess the cost-effectiveness of CBC in the context of COVID-19.…”

Implementation of a Blood-Saving Program in a Pediatric Intensive Care Unit to Reduce Diagnostic Blood Loss

“…There are also other approaches to reduce diagnostic blood loss. Dewan et al described eliminating unnecessary routine blood testing in a selected low-risk cohort of postoperative patients in their PICU [6]. However, it is questionable if this is an option for high-risk patients such as infants in the early postoperative phase after major cardiac surgery.…”

The use of national collaborative to promote advanced practice registered nurse-led high-value care initiatives

“…Recurring and routine labs are a mainstay in the critical care area, but lab testing in a high frequency manner may not lead to changes in a patient's plan of care (Loftsgard & Kashyap, 2016). In the pediatric critical care setting, studies have shown in addition to financial costs, unnecessary lab testing can result in anemia of patients and subsequent blood transfusions (Dewan, Galvez, Polsky et al, 2017). Education, awareness of utilization, and limiting of standard or recurring lab orders have been successful interventions in reducing unnecessary laboratory tests (Dewan et al, 2017).…”

“…In the pediatric critical care setting, studies have shown in addition to financial costs, unnecessary lab testing can result in anemia of patients and subsequent blood transfusions (Dewan, Galvez, Polsky et al, 2017). Education, awareness of utilization, and limiting of standard or recurring lab orders have been successful interventions in reducing unnecessary laboratory tests (Dewan et al, 2017). Education and awareness of utilization are the initial interventions intended to be implemented within this PICU to reduce unnecessary diagnostic testing while monitoring balancing measures such as mortality.…”