Promoting resource stewardship: Reducing inappropriate free thyroid hormone testing
| Autor: | Alanna Weisman, Julie A. Gilmour, Alyse S. Goldberg, Steven Orlov, Robert J. Goldberg, Geetha Mukerji, Hayley Baranek |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Canada Quality management Inservice Training 030209 endocrinology & metabolism Medical Overuse 03 medical and health sciences 0302 clinical medicine Resource (project management) Ambulatory care Internal medicine Medicine Humans 030212 general & internal medicine Academic Medical Centers Hematologic Tests business.industry Health Policy Public Health Environmental and Occupational Health Statistical process control Quality Improvement Test (assessment) Thyroxine Endocrinology Emergency medicine Reflex Triiodothyronine Stewardship business PDCA hormones hormone substitutes and hormone antagonists |
| Zdroj: | Journal of evaluation in clinical practice. 23(3) |
| ISSN: | 1365-2753 |
| Popis: | RATIONALE Free thyroxine (fT4) and free triiodothyronine (fT3) tests are often ordered when not clinically warranted. Preventing laboratory overuse by reducing inappropriate fT4 and fT3 testing is one strategy to promote resource stewardship. OBJECTIVES (1) To characterize the frequency of inappropriate fT4 and fT3 testing and (2) to implement a quality improvement strategy aimed at reducing the number of these tests performed. METHODS Quality improvement tools were used to create sequential change ideas: (1) education of physicians regarding appropriate indications for ordering fT4/fT3 and (2) implementation of a hospital-wide laboratory and forced-function system with a reflex fT4. This study was conducted at an academic ambulatory care hospital in Toronto, Canada. The main outcomes were the differences in weekly median number of thyroid-stimulating hormone, fT4, and fT3 tests performed during the preintervention, education, and reflex periods using the Kruskal-Wallis test and analysis for special cause variation with statistical process control charts. RESULTS The median number of fT4/fT3 processed per week was significantly reduced from 90/39 at baseline to 78/34 posteducation and 59/14 postreflex (P |
| Databáze: | OpenAIRE |
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