TOP 21 - Reducing Redundant Inflammatory Marker Testing for Hospitalized Pediatric Patients

Publication Number: 3750.TOP 21

Mary Yanaros, University of Connecticut School of Medicine/Connecticut Children's Medical Center, West Hartford, CT, United States; Ilana Waynik, Connecticut Children's Medical Center, West Hartford, CT, United States

Background: Sixty-five percent of patients admitted to the Pediatric Hospital Medicine (PHM), Gastroenterology (GI), and Hematology/Oncology (Hem/Onc) services at our hospital have redundant inflammatory marker testing obtained. Redundant inflammatory marker testing creates harm to families and patients through unnecessary venipunctures, increased cost, and uncertainty or anxiety about results that do not change the management of the patient. CRP levels peak at 24-48 hours and procalcitonin at 12-24 hours after the onset of inflammation. Given the similar rate of rise, trending both at the same time does not contribute significant additional information that would lead to a change in management. ESR remains elevated for days to weeks and therefore is not as sensitive or specific for acute inflammation.

Objective: Our SMART aim is to decrease the percentage of PHM, GI, and Hem/Onc patients who have redundant inflammatory marker testing drawn from 65% to 50% by January 31st, 2026.

Design/Methods: We designed and implemented a Quality Improvement project at Connecticut Children's Medical Center for which we obtained an exemption from the IRB. We defined redundant inflammatory marker testing as more than one of the following inflammatory markers obtained at the same time or greater than once in a 24-hour period: CRP, ESR, procalcitonin. Root causes of the problem were examined in a systematic manner (Figure 1), and key drivers and interventions were validated in the medical literature and from root cause discovery (Figure 2). Our interventions were focused on patients admitted to the PHM, GI, and Hem/Onc services and in the Emergency Department because these were identified as the areas with the most redundant inflammatory marker testing. Our primary measure was percentage of patients on these services with redundant inflammatory marker testing. Secondary measures included percentage of patients with any inflammatory marker testing, 7-day readmission rate, and percentage of patients with concurrent CBC test. We utilized the model for improvement with multiple PDSA cycles and measured for significant shift in metrics utilizing statistical process control charts that were updated weekly and shared with frontline providers.

Figure 1. Fishbone Diagram


Figure 2. Key Driver Diagram