94. REDUCING UNNECESSARY TESTING OF VIRAL RESPIRATORY PATHOGENS IN PEDIATRIC PATIENTS

Abstract

Background Although advancements in respiratory viral testing allow for more timely detection of viruses, these tests are expensive and lacking clear evidence of added clinical utility. The Respiratory Pathogen Panel (RPP) used in our institution checks primarily for non-treatable viruses. It accounted for an estimated 2 million dollars in charges from 2015-2017 and was often ordered without documentation of how the test would change clinical management. This raised concern about the clinical utility and added cost of this test for our patients. Aim Statement We aimed to reduce the number of RPP tests ordered on pediatric patients in the pediatric emergency department (ED), inpatient ward and pediatric intensive care unit (PICU) by 50% over 1 year. Interventions Through retrospective chart review, we identified the common clinical divisions and indications in which the RPP was being ordered. We then met with these high utilizers as well as other key stakeholders to develop provider consensus on appropriate utilization of the RPP. Using clinical consensus, along with a focused literature review, we drafted a best practice advisory (BPA), which notably, has been approved but not yet activated in our electronic health record. Measures We used problem solving methodology and a test of change to decrease RPP test utilization. We tracked test utilization in the pediatric ED, PICU and inpatient ward. Results With development of clinical consensus, the number of RPP tests ordered decreased significantly from a median of 19 tests/week in the 2016-2017 respiratory season to a median of 10 tests/week in the 2017-2018 respiratory season in target units. This resulted in an estimated reduction of charges by 54% (from approximately $811,200 to $436,800). Conclusions and Next Steps Establishing a consensus for appropriate use of respiratory viral testing can significantly reduce test utilization and healthcare cost. We anticipate the BPA will sustain resident efforts to date and further reduce unnecessary testing. We predict creating consensus for other tests may be an effective means of ensuring appropriate utilization and reducing costs.