Positive Impact of Clinical Audit on Appropriateness of Laboratory Investigations for Glucose-6-Phosphate Dehydrogenase-Deficient Patients in the Emergency Department.

OBJECTIVES The authors aim to assess the use of investigations for patients with acute hemolytic anemia due to glucose-6-phosphate dehydrogenase (G6PD) deficiency and to ensure guidelines application during practice to reduce the misuse of hospital resources in the emergency department (ED). METHODS A cross-sectional study was conducted at a pediatric tertiary hospital on children presenting to the ED with an acute hemolytic crisis due to G6PD deficiency. Initial investigations were collected from patients' records and compared to local hematology unit guidelines. After a period of basic training and guideline dissemination to the residents, a re-audit was conducted. Percentages of the requested investigations in each audit were calculated and compared using Chi-square test. RESULTS Fifty-three acute hemolytic anemia patients were included in the initial audit and 58 patients in the re-audit. In the initial audit, the most commonly requested nonindicated investigations were the Coombs test and liver enzymes. The requested nonindicated chemistry labs dropped from 74% in the initial audit to 14% in the re-audit (p < 0.001), and Coombs test from 81% to 12% (p < 0.001). CONCLUSIONS A large proportion of requested investigations for children presenting with G6PD acute hemolytic crisis are nonindicated. Education of medical staff about the guidelines and their continuous assessments through audits were effective at reducing unnecessary diagnostic tests.