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Reducing unnecessary neonatal testing in infants of mothers with thyroid disease
Louisa M Churcher1, Julia A Wood1, Kim A Ramjan2,3,4
1Women's and Children's Health, Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia.
Insights
Updated guidelines and staff education significantly reduced unnecessary thyroid function tests in infants under 8 weeks old. This quality improvement initiative ensured appropriate testing for neonatal thyroid disease, improving clinical practice.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Quality Improvement in Healthcare
Background:
- Maternal thyroid disease can impact neonatal thyroid function.
- Newborn screening is standard, but additional thyroid function tests (TFTs) require specific indications.
- Inappropriate TFTs in asymptomatic infants can lead to unnecessary costs and interventions.
Purpose of the Study:
- To evaluate the impact of an updated institutional guideline and staff education on the appropriate use of TFTs in asymptomatic infants (<8 weeks) due to maternal thyroid disease.
- To assess the change in the number of infants tested and the compliance with testing criteria before and after intervention.
Main Methods:
- A retrospective medical record audit was conducted on infants <8 weeks old undergoing TFTs.
- Baseline data collected from July to October 2017, assessing compliance with 2011 guidelines.
- Post-intervention data collected from August to December 2018 after guideline update and staff education in July 2018.
Main Results:
- Initially, 65% of TFTs in infants were for maternal thyroid disease, with only 38% meeting 2011 criteria and 4% meeting 2018 criteria.
- After the intervention, 36% of TFTs were for maternal thyroid disease, with 100% compliance with the updated 2018 guideline.
- The number of infants undergoing TFTs decreased from 40/457 to 14/412.
Conclusions:
- The baseline audit identified a high rate of unnecessary TFTs in healthy neonates.
- Implementing an updated guideline and targeted education effectively improved adherence to appropriate testing protocols.
- The intervention successfully reduced unnecessary testing and enhanced clinical practice for neonatal thyroid assessment.
Aim:
To examine the numbers of asymptomatic infants <8 weeks who had appropriate thyroid function tests (TFTs) in addition to the newborn screening test, because of maternal thyroid disease, before and after the implementation of an updated institutional guideline and staff education.
Methods:
A medical record audit of infants <8 weeks born at a metropolitan teaching hospital, who had TFTs between 1 July 2017 and 31 October 2017 was performed as part of a quality improvement project. Records were reviewed to determine the indication for testing and whether this complied with the current 2011 institutional guideline. A multidisciplinary staff education package was developed to coincide with the publication of an updated guideline in August 2018. Staff education and resources were provided throughout July 2018. A post-intervention audit was repeated between 1 August 2018 and 1 December 2018, assessing compliance with the 2018 guideline.
Results:
In the baseline period, 40 of 457 infants born had TFTs performed, of which 26 of 40 (65%) were for maternal thyroid disease. Of these 10 of 26 (38%) met the 2011 criteria for testing; 1 of 26 (4%) met the updated 2018 criteria. In the post-intervention period, 14 of 412 infants born had TFTs of which 5 of 14 (36%) were tested due to maternal thyroid disease and all were compliant with the new guideline.
Conclusions:
Baseline audit revealed unnecessary neonatal thyroid function testing of healthy babies. Implementation of an updated guideline and a brief, targeted education package successfully increased awareness of the updated recommendations, reduced unnecessary testing and led to improved practice.
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