University of Wisconsin–Madison Medical College of Wisconsin

An Interprofessional Initiative to Address Tests Pending at Discharge for Hospitalized Pediatric Patients

Sarah H. Vepraskas, MD; Erica Chou, MD; Danita Hahn, MD; Sara Lauck, MD; Tracey Liljestrom, MD; Robyn Woolever, BSN RN-BC; Kelly Goetz, BSBA, RN-BC

WMJ. 2024;123(1):29-33.

Download full-text pdf. Download Appendix.


Introduction: Pediatric hospitalized patients often are discharged before all lab tests are completed. Given the risk of medical errors related to inadequate test follow-up, we piloted a collaborative initiative to address tests pending at discharge (TPAD) within our pediatric hospital medicine section. Our objectives were to delineate the responsibilities of case managers and pediatric hospital medicine clinicians in addressing these tests and to establish a communication process.

Methods: We formed an interprofessional team and performed a current state assessment, including a survey to pediatric hospital medicine clinicians to assess time spent following up TPAD and confidence that results were followed up in a timely and appropriate manner. We obtained a list of 1450 individual TPAD for the previous 9 months using an electronic health record data query, from which a list of 26 common and straightforward labs were identified for case manager follow-up. A shared case manager Epic Inbasket for TPAD was created and was checked twice daily. We developed a phased approach to establish a workflow for follow-up.

Discussion: The case manager partnership was launched in 4 phases for the duration of the 6-month pilot. However, due to duplication of work and less value of case managers addressing straightforward labs, the pilot was stopped. A more effective and mutually beneficial role for pediatric hospital medicine attendings and case managers may be to have the case managers address complex TPAD and communicate with primary care clinicians and families.

Author Affiliations: Medical College of Wisconsin, Milwaukee, Wisconsin (Vepraskas, Chou, Hahn, Lauck, Liljestrom); Children’s Wisconsin, Milwaukee, Wis (Woolever, Goetz).
Corresponding Author: Sarah Vepraskas, MD, Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Children’s Corporate Center C560, PO Box 1997, Milwaukee, WI 53226; phone 414.337.7050; email; ORCID ID 0000-0002-6110-2057
Funding/Support: None declared.
Financial Disclosures: None declared.
Acknowledgements: The authors wish to thank the pediatric hospital medicine attendings and case managers for their participation in this pilot initiative. They also wish to thank Kelsey Porada, MA, for assistance with figure creation for the manuscript and Stephanie Koch, lead senior applications analyst, who provided EHR support. Lastly, they wish to thank Children’s Hospital leadership and Department of Pediatrics leadership for support of this initiative.
Share WMJ