P0133 - Improving follow up of anemia screening laboratory results at pediatrics visit

Background: Anemia in early childhood can cause significant adverse effects on development and behavior. The American Academy of Pediatrics recommends universal screening for anemia at a 1-year-old and 2-year-old well-child visit, with additional screening when risk factors are present for anemia. However, studies suggest few infants with anemia receive proper follow-up of laboratory results and monitoring after screening. Though the electronic healthcare record (EHR) has helped to identify some errors, many laboratory results are missed and never addressed. This quality improvement project aimed to increase documentation of laboratory results follow-up to 60% for complete blood counts (CBC) drawn at 1-year-old well-child visits by 03/01/2020 at East Carolina University Pediatric Outpatient Clinic. Our secondary aim is to have a 100% follow-up of abnormal CBC results and decrease the average length of time for documentation to 2 days.

METHODOLOGY: Our quality improvement project was implemented via PDSA cycles (figure 1). Seven residents conducted retrospective data collection by chart reviewing 1-year-old well-child visits to assess if a screening test was performed; if the results were interpreted and the length of time until documentation. One of the barriers of lab results follow-up is physician lack of knowledge to document the lab results. Our first intervention offered education to all physicians and encouraged the lab results to be followed up in a timely manner. We also provided smart phases for normal and abnormal laboratory results documentation. After our first intervention, we found that some results were not sent to the correct physician’s inbox. The second intervention established a new laboratory reporting system to address EHR glitches. A total of 179 CBC test results were analyzed (table 1). The primary outcome of this study is defined by the percentage of interpreted and documented results. Secondary outcomes were the percentage of documented abnormal lab results, and the length of time until documentation.

Discussion: By March 1st, 2020, we observed an increase of the percentage of documented results follow-up from 32.2% to 76.8%. Our secondary outcomes demonstrated a decrease in the average length of time of documentation from 3.45 days to 1.93 days. However, our interventions did not results in 100% follow-up of abnormal CBC results.

Conclusions: Our project increased the percentage of interpreted and documented results and decrease the average length of time until the result note. Future interventions should focus on implementing changes to our EHR system to notify physicians of outstanding lab results that do not have documentation.