When it comes to holding down healthcare costs, reducing variation in clinical practice without compromising quality or patient outcome is a great place to start. Take electrolyte testing, for example. Do hospitals demonstrate similar rates of initial and recurrent laboratory testing for a variety of common pediatric disorders? To answer that question, Tchou et al. (10.1542/peds.2018-1644) decided to perform a multi-center, retrospective cohort study of children who were inpatients at 41 children’s hospitals and note the frequency of initial and recurrent electrolyte testing for 8 common inpatient diagnoses. They used risk-adjusted rates for gastroenteritis to risk-adjust rates of other diagnoses and found the rates of testing in other disorders correlated with those for gastroenteritis, and the rates of subsequent testing paralleled the initial rates for all disorders except gastroenteritis. This simply means some hospitals test at high rates and others at low rates consistently regardless of the underlying condition. What do we make of these findings?
To help us better understand what we can do to reduce variation, we invited Drs. Joel Tieder and Jimmy Beck from Seattle Children’s Hospital to provide an accompanying commentary (10.1542/peds.2019-1334). They point out how overuse and underuse could be responsible for the variations seen in the Tchou et al. study. They also emphasize that clinicians have different risk tolerance or threshold levels to order a lab based on local norms and the culture of a given hospital. Drs. Tieder and Beck offer 7 suggestions to reduce overuse that are worth your attention, each of which could easily become your local hospital’s next quality improvement initiative. Before you order that next set of electrolytes, check out this study and commentary which shed light on the overuse issue, and in doing so made all of us better stewards of ordering tests based on evidence-based rather than arbitrary standards.
