Impact of an Interprofessional Collaborative Quality Improvement Initiative to Decrease Inappropriate Thyroid...

Area of Science:

• Clinical Laboratory Science
• Healthcare Quality Improvement
• Endocrinology

Background:

• Thyroid function tests are frequently ordered inappropriately in acute care, increasing costs and risks.
• Pilot data indicated over two-thirds of thyroid-stimulating hormone (TSH) tests were unnecessary, suggesting significant cost-saving potential.
• Inappropriate laboratory test ordering contributes to diagnostic uncertainty and potential therapeutic errors.

Purpose of the Study:

• To decrease the rate of inappropriate thyroid function test ordering among inpatients and emergency department patients.
• To evaluate the impact of a multipronged initiative on TSH and free T4 test ordering practices.
• To quantify cost savings associated with improved thyroid function test ordering.

Main Methods:

• A controlled, single-center, before-and-after study was conducted at Wake Forest Baptist Medical Center.
• Interventions included electronic ordering changes, provider education, and informational cards, excluding emergency department resident education.
• Primary outcome measured was the change in inappropriate TSH test orders; secondary outcomes included cost savings and inappropriate free T4 orders.

Main Results:

• Inappropriate TSH orders decreased by 13% (P = .062), with reductions across most services except the ED.
• Inappropriate Free T4 orders saw a statistically significant reduction of 30% (P = .01).
• Annual cost savings were estimated at approximately $6,000, with no therapy changes based on inappropriate tests.

Conclusions:

• A multipronged quality improvement initiative led to a significant reduction in inappropriate free T4 orders and cost savings.
• The initiative demonstrated a trend towards reduced inappropriate TSH orders, though not statistically significant.
• The exclusion of the emergency department from direct education may explain the lack of improvement in that setting.