Positive Impact of Clinical Audit on Appropriateness of Laboratory Investigations for Glucose-6-Phosphate Dehydrogenase-
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ORIGINAL ARTICLE
Positive Impact of Clinical Audit on Appropriateness of Laboratory Investigations for Glucose-6-Phosphate Dehydrogenase-Deficient Patients in the Emergency Department Eman Hassan 1
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& Ghadeer Foulath & Mohamed Abdelghany & Ibrahim Sayed & Dina Elkhity & Yasmine El Chazli
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Received: 14 July 2020 / Accepted: 12 November 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objectives The authors aim to assess the use of investigations for patients with acute hemolytic anemia due to glucose-6phosphate 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. Keywords Glucose-6-phosphate dehydrogenase . Acute hemolytic anemia . Clinical audit . Emergency department . Investigations abuse
Introduction Glucose-6-phosphate dehydrogenase (G6PD) deficiency ranks among the most common hereditary enzyme deficiencies worldwide and is notable as a predisposing condition to hemolytic crises [1]. It is estimated that 400 million people are affected worldwide by G6PD deficiency [2] and was reported
* Eman Hassan [email protected] 1
Department of Pediatrics, Hematology and Oncology Unit, Faculty of Medicine, Alexandria University, Port Said St., El Shatby, Alexandria 21526, Egypt
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Department of Pediatrics, Faculty of Medicine, Alexandria University Hospitals, Alexandria, Egypt
to be the most common cause of acute hemolytic anemia (AHA) presenting to the pediatric emergency department (ED) in Egypt [3]. The majority of patients remain asymptomatic until exposed to oxidizing agents as sulpha drugs, Fava beans, infections, or other triggers [4]. An episode of AHA is the most common manifestation of G6PD deficiency in our population [3]. AHA is precipitated when red blood cells are exposed to oxidative stress, causing intravascular
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