A quality-improvement initiative at Yale New Haven Children’s Hospital introduced a clinical protocol to reduce newborn toxicology tests that were unlikely to change care. Before implementation, Black newborns and newborns covered by Medicaid were tested more often than the hospital’s newborn population overall. Testing rates fell markedly during protocol development and remained low after adoption; the team identified no related newborn readmissions for withdrawal or other adverse events among infants without previously identified prenatal substance exposure. The experience suggests that clinically targeted testing, interdisciplinary collaboration, and continued family support can reduce unnecessary testing and inequities. The authors report institutional quality-improvement findings rather than results from a randomized trial.
