A decision support tool reduces blood gas testing in a paediatric intensive care unit; a before and after study

To investigate the effect of a quality intervention on blood gas testing in a Paediatric Intensive Care Unit (PICU). A single centre, before and after study was performed at the Royal Children’s Hospital between February 2024 and February 2025. The number of blood gas tests were compared between two sixth month periods, before and after the introduction of a decision support tool and education program. The primary outcome was the number of blood gas tests per bed day. The number of blood gas tests in the pre and post intervention periods were 16,144 and 12,798, respectively. The corresponding median number of blood gas tests per bed day were 3.8 [0.9–6.2] compared to 3.4 [1.1–5.3] (p = 0.05). In multivariable analysis, accounting for age, Paediatric Index of Mortality, the proportion receiving mechanical ventilation, renal replacement therapy and extracorporeal membrane oxygenation, there was a 46% higher number of blood gases per bed day in the pre intervention period; 1.46 (95%CI; 1.33–1.66); p < 0.0001. Similar findings were observed in subgroups of children admitted to the general intensive care unit (ICU), cardiac ICU, those receiving ECMO and liver transplant. Accounting for bed days per period an estimated $103,865 cost saving occurred in the post intervention period. A quality improvement initiative incorporating a clinical decision support tool and education, reduced the number of blood gas tests overall, and in subgroups. This amounted to an estimated 20% reduction in direct blood gas test healthcare costs.