P3.E089: Improving Lead Screening Rates by age 2 in a Multi-Site Academic Practice

Purpose/Objectives: The American Academy of Pediatrics recommends blood lead testing for all pediatric patients at age 12 and 24 months of age. The importance of testing for blood level lessons comes from the known risk of lead poisoning leading to medical complications particularly developmental delay in pediatric patients. Our practice location found that routine blood lead level screening was not being completed for all patients across the practice by age two.

Design/Methods: Surveying of clinic staff determined there was variation in the age at which blood lead level testing was conducted. Also, there were barriers in obtaining the specimen with patients having an order placed but never having specimen drawn. A goal was set to increase blood lead level sample rates by 10% within one year. Point of care testing options were explored and a workflow created to obtain a blood lead specimen on every patient at their 12-month well child visit.

Results: Prior to initiation of point of care obtaining of blood specimen, practice wide the blood level testing results were 58% (986/1709 patients) by 2 years of age. Twelve months following implementation of new workflow, total practice site rate improved to 77% (1,277/1,663 patients).

Conclusion/Discussion: Through a standardized workflow, designated point person at each location site, POC specimen obtaining and buy in from clinical staff, a 19% increase in blood lead level testing was demonstrated in a twelve-months’ time. Initial initiative role out experienced setbacks with specimen return times and all sites initiating a standardized workflow. Coordinated efforts with lab representative enhanced turn around times and clinic role out was delayed three months at one practice site while awaiting ability to have staff and equipment to conduct lead testing. Continued future focus will be on determining if a need for two separate lead levels, one at 12 months and one at 24 months of age as well as repeat testing in high-risk children throughout their continued growth and development should be standardized practice wide.