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Optimizing Utilization of Laboratory Investigations in Neonatal Intensive Care Unit

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Abstract

Objective

To optimize utilization of laboratory tests by measuring baseline rates and appropriateness of investigations, assessing the barriers to rational use, and developing and implementing an educational package for resident doctors.

Design

Quality improvement study.

Setting

Neonatal intensive care unit (NICU) from August, 2015 to December, 2016.

Participants

All neonates admitted in NICU and resident doctors working in NICU.

Intervention

Addressing barriers, educational package, posters and group discussions.

Main outcome measures

Laboratory test rates for hematology, biochemistry and blood gas. Proportion of tests judged to be inappropriate.

Results

At the baseline, median (IQR) laboratory test rate patient/day was 0.6 (0.2–1.5) and one-fifth of tests were classified as inappropriate. Mechanical ventilation and sepsis were independent predictors of laboratory test rates but could explain only 35% of the disparities, indicating variations in clinical practice. Following a short period of intervention, hematology investigations showed a trend towards reduction, though overall test rates did not change significantly.

Conclusions

Addressing barriers, creating awareness and educational interventions were able to bring down hematology laboratory test rates in a short period. A longer period of sustained intervention is required to demonstrate significant effects on test ordering behavior.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, PGIMER, Chandigarh, 160 012, India

    Sowmya Devarapalli, Shiv Sajan Saini, Venkataseshan Sundaram & Praveen Kumar

Authors
  1. Sowmya Devarapalli
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  2. Shiv Sajan Saini
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  3. Venkataseshan Sundaram
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  4. Praveen Kumar
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Corresponding author

Correspondence to Praveen Kumar.

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Devarapalli, S., Saini, S.S., Sundaram, V. et al. Optimizing Utilization of Laboratory Investigations in Neonatal Intensive Care Unit. Indian Pediatr 55, 784–787 (2018). https://doi.org/10.1007/s13312-018-1382-5

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  • DOI: https://doi.org/10.1007/s13312-018-1382-5

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