Reducing Home Labs for Pediatric Patients With Solid Tumors: Impact of a Novel Clinical Practice Guideline on Safety, Cost, and Quality of Life.

introductionFor pediatric patients with solid tumors, the use of growth factors following chemotherapy evolved from daily filgrastim to pegylated filgrastim. Currently, post-chemotherapy laboratory work is obtained to monitor for transfusion needs rather than count recovery. We implemented a clinical practice improvement project aimed at identifying the minimum number of labs required to assess transfusion needs, based upon disease and chemotherapeutic regimen, to design guidelines to safely reduce the number of home labs for targeted solid tumor diagnoses by 50% over 2 years.

methodsWe retrospectively sourced data for a cohort of solid tumor diagnoses and chemotherapeutic regimens to determine the reasons why laboratory work was obtained. We subsequently developed new lab monitoring guidelines and conducted serial teaching sessions and prospective data monitoring post-implementation.

resultsPost-implementation data analysis resulted in a reduction in home laboratory draws by 71%, exceeding our a priori set 50% goal. There were no adverse events. Estimated cost savings over 2 years, accounting for provider follow-up, price per lab, and visiting nurse sessions, were $69,898. This reduction in home laboratory draws was interpreted, by decision tree analysis, to reduce the risk and costs associated with central line infections and improve quality of life.

conclusionOur findings indicate that there is a cohort of solid tumor diagnoses that do not require twice weekly bloodwork to monitor for transfusion needs. Implementation of a novel clinical practice guideline resulted in a safe reduction in labs leading to optimized resource utilization, decreased costs, and perceived improvement in quality of life.