Improving pediatric healthcare through smarter lab testing: embracing value-based stewardship

Amid growing economic pressures and evolving healthcare expectations, the U.S. health system is undergoing a significant shift toward value-based care. As part of this transformation, clinical laboratories are being called upon to move beyond high test volumes toward “practicing to value,” – a model that emphasizes delivering only the most clinically necessary tests to improve patient outcomes, reduce waste and lower costs.

At Baylor College of Medicine and Texas Children’s Hospital, clinical and pathology teams are leading this charge. Leveraging the institution’s long-standing commitment to pediatric excellence, the Texas Children’s laboratory is implementing innovative laboratory stewardship strategies that support effective test utilization while ensuring high-quality, timely diagnostics for children.

Quality improvement in healthcare delivery is not a new concept. Since the publication of the seminal Institute of Medicine report, “To Err is Human and Crossing the Quality Chasm,” healthcare stakeholders have been striving to build a safer, more effective system. In the laboratory context, this means delivering patient-centered care: the right test for the right patient at the right time. It also involves test repetition only when clinically warranted and the provision of results in a timely manner to support rapid diagnosis and patient monitoring. Good stewardship means asking not only can we do a test but should we.

As Section Chief, I am proud to lead the Clinical Chemistry Group and we have been at the forefront of advancing laboratory stewardship through both clinical laboratory practice and research.

In our recent review published in Critical Reviews in Clinical Laboratory Sciences, which includes the associate director of the chemistry lab, Dr. Adetoun Ejilimele, and two fellows, Dr. Anil Chokkalla, the previous clinical chemistry fellow, and Ridwan Ibrahim, the current clinical chemistry fellow, we emphasize the importance of evaluating outcomes after stewardship interventions – something that often has been overlooked in traditional laboratory management.

Examples include:

• High-sensitivity troponin-I: Enhances cardiac care by improving the detection of myocardial injury, ultimately leading to better outcomes.
• Neutrophil gelatinase-associated lipocalin (NGAL): Serves as an earlier and more sensitive marker for acute kidney injury, enhancing the ability to intervene promptly.
• Vitamin D testing: Refined strategies help prevent overuse, ensuring that testing is done only when clinically indicated.

In our review, we highlight a couple of impactful, Texas Children’s led examples of smart test utilization; these were all done in collaboration with clinical colleagues:

• The introduction of the Amnisure test in a point-of-care setting in obstetrics has improved care for mothers and babies by facilitating prompt diagnosis of premature rupture of membranes (PROM). The implementation resulted in a threefold increase in timely deliveries at Texas Children’s Hospital Pavilion for Women.
• At the behest of our coagulation team, which works closely with other clinical teams at the bedside, we also deployed Von Willebrand factor (vWF) multimer testing, mainly for acquired von Willebrand syndrome, and this significantly shortened turnaround times of testing by a factor of three, enhancing care for pediatric patients with bleeding disorders.

Ultimately, strategic laboratory stewardship is vital in pediatric care, where timely and appropriate testing can make a profound difference. Every test we run should add value to the patient’s care. Our responsibility as laboratory professionals is to ensure that diagnostic tools are used not just correctly but wisely.

Looking ahead, continued improvements in laboratory testing quality, the adoption of cutting-edge technologies, continued research, age-specific testing guidelines and collaboration with clinical partners will be essential to furthering our leadership in laboratory stewardship. By doing so, the institution continues to fulfill its mission of providing personalized, high-quality care to every child – one test at a time.

By Dr. Sridevi Devaraj, medical director, Chemistry and Point of Care, Texas Children’s Hospital; Director of Laboratories, Texas Children’s Specialty Care, Bellaire and Clearlake, professor of pathology & Immunology, Baylor College of Medicine