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HomeNewsElectronic Order Modifications Can Curb Unnecessary Respiratory Viral Testing

Electronic Order Modifications Can Curb Unnecessary Respiratory Viral Testing

(Reuters Health) – Unnecessary nasopharyngeal swabs for respiratory viral testing can be reduced in the emergency department (ED) and on pediatric medicine wards with changes to electronic orders, audits, feedback, and education, a recent study suggests.

Researchers’ goal was to assess whether a multifaceted initiative to reduce respiratory viral testing could curb unnecessary tests by 50% in the ED and by 25% on pediatric medicine wards over 36 months. The initiative included utilization of two newer, more effective tests when needed, as well as electronic order forms with force functions; feedback and audits to monitor shifts in testing over time; and clinician education on the importance of reducing tests that are not indicated.

Over the study period, the mean respiratory viral testing rate dropped from 3.0% to 0.5% of ED visits and from 44.3 to 30.1 tests per 1,000 patient-days on pediatric medicine wards, the study team reports in Pediatrics.

“At baseline, the majority of the respiratory viral testing in our center was completed on ED patients who were well enough to be discharged home and the result of these tests were generally not being followed-up or acted upon,” said lead author Dr. Olivia Ostrow, a staff physician in pediatric emergency medicine at the Hospital for Sick Children and an assistant professor at the University of Toronto.

Testing was frequently being performed almost reflexively, but not based on evidence-based guidelines or with critical thinking to determine how the result would actually benefit the patient, Dr. Ostrow said by email.

The effort to reduce unnecessary testing in the study revolved around several components. First, a respiratory viral testing pathway was developed for both the ED and pediatric wards to identify evidence-based guidelines for targeting only specific populations most likely to benefit from tests. Then, the pathway was integrated into electronic medical records with a force function requiring clinicians to select from among the pre-determined indications for testing to place orders.

In addition, education and training initiatives focused on reminding clinicians of best practices around testing, and to address barriers to compliance. Then, audits provided physicians with individualized data as well as aggregated data on their ordering patterns for respiratory viral testing so they could see how often they and their colleagues were compliant with the testing pathway established to cut back on unnecessary tests.

One limitation of the study is that several factors can impact the necessity of testing such as seasonality of viruses as well as the COVID-19 pandemic, the authors note. Because so many different components of the intervention were implemented over the study period, it wasn’t possible to determine which individual components might have had the biggest impact on testing rates, they add.

“Comprehensive respiratory viral testing can be beneficial in certain instances, such as to avoid antibiotic use, imaging or even hospitalization, but many patients have comprehensive viral testing completed without any indication or benefit,” Dr. Ostrow said. “Tests shouldn’t be ordered just because we can, but because we should to improve the care of our patients.”

SOURCE: Pediatrics, online January 14, 2022.

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