[Reduction of complimentary prescription examinations in a pediatric emergency department].
Numerous biological tests and X-rays are prescribed though the patient's clinical status does not warrant them. They are a source of extra work, extra costs, and painful and potential measurement errors.


OBJECTIVE
To reduce unnecessary tests in four frequent situations (bronchiolitis, gastroenteritis, unexplained fever in children more than three months of age, asthma attack) at the pediatric emergency department of the Robert-Debré hospital (Paris).


METHODS
Using a 'before/after' intervention survey, the intervention consisted of a modification of the request forms by adding prescription recommendations. All the children presenting with any one of the four targeted pathologies were included during the two 2-week periods.


RESULTS
Test requests were reduced from 0.98 test per child to 0.77 (p = 0.02). The percentage of necessary tests increased from 33 to 50% (p < 0.0001); the percentage of children who underwent unnecessary blood samples decreased from 30 to 15% (p = 0.01). At the same time, the percentage of tests which were appropriate but not prescribed did not increase during the intervention period.


CONCLUSIONS
It is possible to reduce unnecessary tests in an emergency pediatric department by adding recommendations to the request form. Unfortunately, the effects of such intervention do not last if the recommendations are not regularly recalled.
Surcin
L
L
Service de santé publique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019, Paris, France.
Bloch
J
J
Vitout-Brot
C
C
D001249:Asthma / Q000175:diagnosis / Q000628:therapy; D001988:Bronchiolitis / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000706:statistics & numerical data*; D003363:Cost Control; D003954:Diagnostic Services / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005334:Fever / Q000209:etiology / Q000628:therapy; D005602:France; D005759:Gastroenteritis / Q000175:diagnosis / Q000628:therapy; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D019564:Unnecessary Procedures