Rethinking Blood Testing in Pediatric Cancer Patients: A Quality Improvement Approach

Andrew M Grant; Felicity A Wright; Laura R M Chapman; Eleanor Cook; Renee Byrne; Tracey A O'Brien

doi:10.1097/pq9.0000000000000552

Rethinking Blood Testing in Pediatric Cancer Patients: A Quality Improvement Approach

Pediatr Qual Saf. 2022 Jun 14;7(3):e552. doi: 10.1097/pq9.0000000000000552. eCollection 2022 May-Jun.

Authors

Andrew M Grant¹, Felicity A Wright^{1

2}, Laura R M Chapman¹, Eleanor Cook¹, Renee Byrne¹, Tracey A O'Brien^{1

3}

Affiliations

¹ Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney Children's Hospital's Network, Sydney, NSW, Australia.
² Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
³ School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, NSW, Australia.

Abstract

Introduction: The overuse of blood tests burdens the healthcare system and can detrimentally impact patient care. Risks of frequent blood sampling include infection and clinician-induced anemia, which can negatively impact patients and their families. Pediatric cancer patients are particularly vulnerable as they are immunocompromised with a small blood volume. Four blood tests had become a daily practice. Therefore, we aimed to reduce the number of blood tests taken per bed day within the inpatient pediatric cancer unit by 15% within 8 months.

Methods: This quality improvement project combined several strategies to reduce test frequency and empower clinicians on the rationale for blood test ordering. Recommendations were developed collaboratively presented in a summary table. Targeted behavior-change methodology built engagement and momentum for the change. All clinicians were challenged to STOP and THINK about why a test is necessary for each patient. The primary outcome measure was the frequency of the tests taken per bed day. Frequency was compared between pre- and postimplementation plus follow-up periods across 2019-2021.

Results: 26,941 blood tests were captured in 1,558 admissions. The intervention led to an overall blood test reduction of 37% over 8 months. Liver Function Tests were the standout, with a 52% decrease in test frequency.

Conclusions: A strategy incorporating education and culture change, combined with clear guidance on testing frequency, significantly reduced the ordering frequency of blood tests without increased patient harm.

Keywords: blood test; oncology; pediatric; quality improvement.