Diagnostic Testing During Pediatric Hospitalizations: The Role of Attending In-House Coverage and Daytime Exposure.

TitleDiagnostic Testing During Pediatric Hospitalizations: The Role of Attending In-House Coverage and Daytime Exposure.
Publication TypeJournal Article
Year of Publication2020
AuthorsRyskina KL, Dynan L, Stein R, Fieldston E, Palakshappa D
JournalAcad Pediatr
Volume20
Issue4
Pagination508-515
Date Published2020 May - Jun
ISSN1876-2867
KeywordsAcademic Medical Centers, Child, Cross-Sectional Studies, Diagnostic Imaging, Diagnostic Tests, Routine, Hospitalization, Humans
Abstract

OBJECTIVE: Overuse of diagnostic tests is of particular concern for pediatric academic medical centers. Our objective was to measure variation in testing based on proportion of hospitalization during the day versus night and the association between attending in-house coverage on the teaching service and test utilization for hospitalized pediatric patients.

METHODS: Electronic health record data from 11,567 hospitalizations to a large, Northeastern, academic pediatric hospital were collected between January 2007 and December 2010. The patient-level dataset included orders for laboratory and imaging tests, information about who placed the order, and the timing of the order. Using a cross-sectional effect modification analysis, we estimated the difference in test utilization attributable to attending in-house coverage.

RESULTS: We found that admission to the teaching service was independently associated with higher utilization of laboratory and imaging tests. However, the number of orders was 0.76 lower (95% confidence interval:-1.31 to -0.21, P = .006) per 10% increase in the proportion in the share of the hospitalization that occurred during daytime hours on the teaching services, which is attributable to direct attending supervision.

CONCLUSIONS: Direct attending care of hospitalized pediatric patients at night was associated with slightly lower diagnostic test utilization.

DOI10.1016/j.acap.2019.09.008
Alternate JournalAcad Pediatr
PubMed ID31648058
PubMed Central IDPMC7170750
Grant ListK08 AG052572 / AG / NIA NIH HHS / United States
K23 HL146902 / HL / NHLBI NIH HHS / United States