A 100-Day Workout Quality Improvement Project to Improve Value for the Care of Mental Health Conditions in a Pediatric Emergency Department

BACKGROUND: The escalating mental health crisis among children has led to increased visits to the emergency department. Routine laboratory testing in children with behavioral and mental health (BMH) concerns is a common practice but rarely identifies clinically meaningful abnormalities. OBJECTIVE: We aimed to reduce low-value care for patients requiring admission to our inpatient psychiatry unit by decreasing unnecessary testing and costs by 25%. METHODS: We conducted a "100-day workout quality initiative" which used Lean Six Sigma methodology to implement an evidenced-based clinical pathway. RESULTS: After implementation, routine laboratory testing decreased from 96% to 20.8%. Overall costs associated with psychiatry admission in our institution decreased by 10%, with no adverse impact on clinical outcomes. CONCLUSIONS: This approach demonstrates a sustainable model for reducing low-value care in the emergency department setting for patients with BMH complaints.