There were no adverse events related to missed labs after a pediatric emergency department (ED) stopped conducting routine bloodwork among patients requiring psychiatric consultations, according to a poster presented last week at the American Academy of Child and Adolescent Psychiatry 2026 Annual Meeting.Why It’s Relevant
In an effort to reduce low-value interventions for pediatric patients in the ED, the American Academy of Pediatrics developed a Choosing Wisely list that includes a recommendation against routine laboratory tests in the medical clearance process for patients who require inpatient psychiatric admission unless clinically indicated.
By the Numbers
- Researchers launched a quality improvement initiative at a pediatric ED from November 2024 to August 2025 to increase compliance with the Choosing Wisely recommendation.
- Among 101 ED patients under age 17 who required inpatient psychiatric admission after the interventions began, 50% had no bloodwork. By contrast, before the intervention began, all admitted children received a workup, regardless of clinical indication.
- Compliance with the Choosing Wisely recommendation—blood-testing only when a clinician provided a documented reason—across all pediatric encounters with a psychiatry consult increased from 66% to 99% overall, with compliance among discharged patients increasing from 80% to 100% and among admitted patients from 43% to 90%.
- No patients required a transfer back to medical services for missed diagnoses or medical complications.
The Other Side
This initiative was reinforced with educational interventions and monthly feedback with psychiatry and pediatric staff, so a less intensive operational change might not be as successful. Whether compliance will remain strong in the long term, as new staff come in, is also unknown.
Takeaway Message
“Especially if a patient is going through a psychiatric emergency, having to subject them to a blood draw can add to the challenge of being in the pediatric ED,” lead author Lara Tang, M.D., told Psychiatric News. “What we’re aiming to do is essentially limit the amount of distress and challenges that a patient might experience when they’re there.”
Related Information
Source
Lara Tang, et al. Reducing unnecessary medical screening for pediatric psychiatric admissions in the ED: a quality-improvement approach to implementing Choosing Wisely recommendations. Annual Meeting of the American Academy of Child and Adolescent Psychiatry. Presented October 28, 2026.
(Image: Getty Images/iStock/Olga Yastremska)
