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Body:Bioequivalence experimental study designs play a pivotal role in testing the effectiveness of various treatments. Key among these are the repeated measures, cross-over, carry-over, and Latin square designs. In the repeated measures design, each subject receives all treatments, allowing for temporal comparisons. This type of design is useful in reducing variability but requires careful planning to avoid bias.The cross-over design, an economical method, involves sequential administration of...
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Author Spotlight: Accurately Assessing Thyroid Hormone-Driven Motor Alterations in Mouse
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Reducing free thyroid hormone testing through multiple Plan-Do-Study-Act cycles.

Jennifer Taher1, Daniel R Beriault2, Drake Yip3

  • 1Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.

Clinical Biochemistry
|May 17, 2020
PubMed
Summary
This summary is machine-generated.

Implementing quality improvement strategies significantly reduced free thyroid hormone (fT4 and fT3) testing by 39% and 47%, respectively. Multiple Plan-Do-Study-Act cycles refined interventions for optimal results in laboratory testing.

Keywords:
Balancing measuresFree thyroid hormonesLaboratory utilizationQuality improvementReflexive testing

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Quality Improvement Science

Background:

  • Free thyroid hormones (fT4, fT3) are frequently ordered lab tests, often without clear clinical indication.
  • Inappropriate testing contributes to unnecessary healthcare costs and potential patient harm.
  • Previous studies have explored strategies to curb unnecessary fT4 and fT3 assays.

Purpose of the Study:

  • To implement a quality improvement (QI) framework utilizing Plan-Do-Study-Act (PDSA) cycles.
  • To identify optimal strategies for reducing inappropriate free thyroid hormone testing.
  • To achieve a 30% reduction in fT4 and fT3 testing within 12 months at a tertiary hospital.

Main Methods:

  • Employed the Model for Improvement framework with three key change ideas.
  • Implemented a forced function reflex system for free thyroid hormone testing.
  • Modified test requisitions and introduced a thyroid-stimulating hormone (TSH)-only option, refining interventions based on PDSA cycles.

Main Results:

  • The first PDSA cycle reduced fT4 testing by 24% and fT3 by 18%.
  • The second PDSA cycle further decreased fT4 by 16% and fT3 by 29%.
  • No significant increase in laboratory add-on calls for free thyroid hormones was observed post-intervention.

Conclusions:

  • Achieving substantial reductions in free thyroid hormone testing requires iterative PDSA cycles.
  • Continuous monitoring of process and balancing measures is crucial for refining interventions.
  • Overall fT4 and fT3 testing decreased by 39% and 47%, respectively, exceeding the initial goal.