Joint Commission journal on quality and patient safety · 2026
Decreasing Herpes Simplex Virus (HSV) Testing Turnaround Time for Infants in a Hospital Setting: A Continuous Quality Improvement Project.
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Reid Miranda J, Chang Peter S, Beal Stacey G, Rand Kenneth H, Lossius Michele N
Аннотация
BACKGROUND: Febrile infants require hospitalization and intravenous antiviral administration until providers rule out herpes simplex virus (HSV) infection. This study aimed to reduce the length of stay (LOS), direct hospitalization costs, and turnaround time (TAT) of lab results by increasing HSV lab processing frequency.
METHODS: The authors implemented three Plan-Do-Study-Act (PDSA) cycles to increase the frequency of HSV testing in the lab. PDSA 1 (2016-2017) increased processing frequency from three to five days per week (n = 61 patients). PDSA 2 (2018-2019) used the results from PDSA 1 to justify increasing processing frequency to seven days a week (n = 64 patients). PDSA 3 (2022-2023) rebuilt the coalition following staffing changes resulting from COVID-19 to ensure fidelity in daily processing (n = 72 patients). The research team extracted data on patient LOS, TAT, and direct care costs from the electronic medical record. Differences between PDSA cycles were assessed using Kruskal-Wallis and Dunn Tests.
RESULTS: TAT decreased from a median of 35.1 hours for cerebrospinal fluid and 30.5 hours for skin testing in the baseline period to 2.5 and 5.5 hours, respectively, in PDSA 3 (p < 0.001). LOS decreased from a median of 2.4 days in the baseline period to 1.9 days in PDSA 3 (p < 0.01). The direct cost of care decreased from a baseline median of $4,348 to $4,164 in PDSA 3 (p < 0.05).
CONCLUSION: This study demonstrated a large reduction in TAT, with a moderate decrease in LOS and a more moderate impact on direct care costs with increased processing frequency. Other hospitals could use similar collaborations between pediatrics and pathology personnel to improve the quality of care in the treatment of febrile infants nationwide.
METHODS: The authors implemented three Plan-Do-Study-Act (PDSA) cycles to increase the frequency of HSV testing in the lab. PDSA 1 (2016-2017) increased processing frequency from three to five days per week (n = 61 patients). PDSA 2 (2018-2019) used the results from PDSA 1 to justify increasing processing frequency to seven days a week (n = 64 patients). PDSA 3 (2022-2023) rebuilt the coalition following staffing changes resulting from COVID-19 to ensure fidelity in daily processing (n = 72 patients). The research team extracted data on patient LOS, TAT, and direct care costs from the electronic medical record. Differences between PDSA cycles were assessed using Kruskal-Wallis and Dunn Tests.
RESULTS: TAT decreased from a median of 35.1 hours for cerebrospinal fluid and 30.5 hours for skin testing in the baseline period to 2.5 and 5.5 hours, respectively, in PDSA 3 (p < 0.001). LOS decreased from a median of 2.4 days in the baseline period to 1.9 days in PDSA 3 (p < 0.01). The direct cost of care decreased from a baseline median of $4,348 to $4,164 in PDSA 3 (p < 0.05).
CONCLUSION: This study demonstrated a large reduction in TAT, with a moderate decrease in LOS and a more moderate impact on direct care costs with increased processing frequency. Other hospitals could use similar collaborations between pediatrics and pathology personnel to improve the quality of care in the treatment of febrile infants nationwide.