Optimization of Pregnancy Testing in the Emergency Department: A Quality Improvement Initiative

BACKGROUND: At our institution, a review of emergency department pregnancy testing identified excess use of serum quantitative (quant) human chorionic gonadotropin (hCG) when only a binary result was clinically indicated. Additionally, we observed delays in point-of-care (POCT) urine hCG turnaround time. In response, provider education and electronic health record default modifications were implemented to promote serum qualitative (qual) hCG. METHODS: Following a pre/post intervention design, we reviewed emergency department pregnancy tests over 2 periods: July 1, 2024-June 30, 2025, and September 1, 2025-February 28, 2026. Outcomes included utilization patterns, order-to-result time, per-test cost, appropriateness of serum quant hCG, and test completion. RESULTS: Inappropriate serum quant hCG orders decreased from 42.2% to 36.2%. Serum qual hCG use increased from 8.4% to 55.4%, while POCT and serum quant hCG use decreased from 71.8% to 33.0% and 19.8% to 11.6%, respectively. POCT order-to-result time decreased from 92.2 to 77.6 minutes, with no significant change in serum turnaround time. Mean cost per test decreased from $211.08 to $147.79, a $63.29 (30%) reduction. Pregnancy test completion increased from 78.8% to 89.8%. CONCLUSIONS: Pairing electronic health record default order modification with targeted provider education reduced low-yield quant hCG ordering and increased use of serum qual hCG testing, reducing costs without compromising diagnostic accuracy. Additionally, POCT urine hCG turnaround times decreased and overall pregnancy test completion rates increased, suggesting improved workflow efficiency with greater use of serum-based testing.