Promoting Choosing Wisely Thyroid Function Test Guidelines in a Large Pediatric Hospital System.

Area of Science:

• Clinical Chemistry
• Quality Improvement
• Health Services Research

Background:

• Inappropriate free thyroxine (fT4) testing is a common issue in clinical practice.
• A need exists to optimize diagnostic testing strategies in pediatric healthcare settings.

Purpose of the Study:

• To implement and evaluate a quality improvement initiative aimed at reducing non-indicated free thyroxine (fT4) testing in a pediatric hospital system.
• To identify and establish an optimal approach for appropriate fT4 test ordering.

Main Methods:

• Evidence-based guidelines and best practices informed the development of a reflex testing strategy (thyroid-stimulating hormone with reflex to fT4).
• Clinical decision support tools were integrated into electronic health records for outpatient thyroid panels.
• Provider education, feedback, and revisions to order sets were conducted over a 44-month period.

Main Results:

• A significant reduction in co-ordering of fT4 with thyroid-stimulating hormone was observed, decreasing from 67% to 15% among non-endocrinology providers.
• The utilization of reflex fT4 testing increased from 0% to 77%.
• Over three years, 5179 fewer fT4 tests were performed, resulting in direct cost savings of $45,800.

Conclusions:

• The implementation of a reflex fT4 testing strategy, coupled with clinical decision support and provider education, effectively reduced inappropriate fT4 orders.
• The study demonstrated a sustainable reduction in fT4 testing and achieved significant cost savings.
• This quality improvement model offers a scalable approach for optimizing thyroid function test ordering in pediatric populations.