Quality Improvement Initiative to Reduce Inappropriate Viral Testing within the Pediatric Emergency Department.

Abstract

Introduction: The American Academy of Pediatrics Section on Emergency Medicine's Choosing Wisely Campaign includes recommendations discouraging comprehensive viral panel testing in children with suspected respiratory viral illness. In the year preceding project implementation, our free-standing pediatric emergency department (PED) ordered comprehensive respiratory pathogen panels (RPPs) in 11.9% of all visits, and 50% of those lacked a clinical indication. This project aimed to reduce the percentage of PED visits with RPP orders from 11.9% to 9% over a 6-month viral respiratory season.

Methods: We conducted four major interventions over 2 plan-do-study-act cycles. Interventions included developing a clinical guideline for viral testing, performing provider education, introducing a narrower-spectrum Quad (influenza A/B, COVID-19, and respiratory syncytial virus) polymerase chain reaction (PCR) test, and adding an order-entry indication requirement for RPPs, which also served as a just-in-time educational tool for providers. We tracked data via a clinical dashboard and through periodic chart reviews.

Results: Of the 43,283 patient visits during the project period, the percentage of PED RPP orders decreased from 11.9% at baseline to 6.8% during the intervention period and remained at 6.8% in the following respiratory season. The project had sustained cost savings of over $300,000 in RPP testing each year. The decrease in RPP orders did not lead to an increase in the cumulative use of other viral tests.

Conclusions: This quality improvement initiative significantly improved and sustained comprehensive viral PCR testing practices in the PED without increasing the use of alternative respiratory viral testing.