title: Implementation of a quality improvement program to improve sweat test performance in a pediatric hospital.
abstract: BACKGROUND
  All positive screening of newborns for cystic fibrosis using the dried blood spot 2-tiered immunoreactive trypsinogen/DNA method requires subsequent sweat chloride testing for confirmation. Obtaining an adequate volume of sweat to measure chloride is a challenge for many cystic fibrosis centers across the nation. The standard for patients older than 3 months is less than 5% quantity not sufficient (QNS) and for patients 3 months or younger is less than 10% QNS.
  
  
  OBJECTIVE
  To set up a quality improvement (QI) program for sweat testing to improve QNS rates using the Wescor Macroduct (Wescor, Inc, Logan, Utah) method at Texas Children's Hospital's laboratory, Houston, Texas.
  
  
  METHODS
  Single-center study.
  
  
  RESULTS
  Quantity not sufficient rates were evaluated for 4 months before and 8 months after implementation of the QI program for patients aged 3 months or younger and those older than 3 months. The QI program included changes in technician training, service, site of collection, mode of collection, weekly review, and forms to screen patients for medications that may alter sweat production. A marked improvement was observed in the rates of QNS, which declined considerably from 16.7% to 8.5% (≤3 months old) and from 9.3% to 2.2% (>3 months old) after implementation of the QI initiative in both age categories.
  
  
  CONCLUSIONS
  This report demonstrates the effectiveness of the QI program in significantly improving QNS rates in sweat chloride testing in a pediatric hospital.
authors.affiliation: From the Texas Children's Hospital and Department of Pathology, Baylor College of Medicine, Houston, Texas.
authors.forename: Barina
authors.initials: B
authors.lastname: Aqil
authors.forename: Aaron
authors.initials: A
authors.lastname: West
authors.forename: Michael
authors.initials: M
authors.lastname: Dowlin
authors.forename: Estella
authors.initials: E
authors.lastname: Tam
authors.forename: Cristy
authors.initials: C
authors.lastname: Nordstrom
authors.forename: Gregory
authors.initials: G
authors.lastname: Buffone
authors.forename: Sridevi
authors.initials: S
authors.lastname: Devaraj
mesh_terms: D002712:Chlorides / Q000032:analysis*; D003550:Cystic Fibrosis / Q000175:diagnosis*; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007478:Iontophoresis; D008403:Mass Screening / Q000379:methods / Q000592:standards; D015997:Neonatal Screening / Q000379:methods / Q000592:standards; D010862:Pilocarpine; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D013542:Sweat / Q000737:chemistry*; D013781:Texas
chemical_list: D002712:Chlorides; D010862:Pilocarpine