Education and Visual Reminders Fail to Reduce Overuse and Waste in Interhospital Transfers to a Pediatric Intensive Care Unit

Introduction: As healthcare costs continue to rise, initiatives to reduce costs while maintaining high-quality care become a priority. Nonclinically indicated studies add to this cost, especially during interfacility transfers when studies are often repeated. Also, unnecessary evaluations add to nonmonetary costs such as pain, radiation exposure, and iatrogenic anemia. This study aimed to establish the frequency of redundant testing on interfacility transfers to the pediatric intensive care unit (PICU) and then implement an education-based quality improvement strategy for waste reduction.

Methods: In the preintervention period (September 2018-February 2019), we collected data on patients transferred to the PICU from any outside facility. Investigators evaluated studies repeated within 6 hours and deemed them redundant or indicated. We then determined a rate of patients with redundant studies as the first aim. This result prompted an educational intervention focused on testing stewardship. Investigators then collected data in the postintervention period (July-December 2019) and compared the rate of redundant studies.

Results: Study efforts identified 150 patients in the preintervention period and 131 in the postintervention period, establishing a 21%-25% frequency of redundant testing. Education and visual reminders failed to reduce this testing.

Conclusion: This study established a baseline rate of redundant testing on transferred patients to the PICU. An educational intervention alone did not produce significant change.