Developing Benchmarking Metrics for Appropriate Ordering of Vitamin D, Thyroid Testing, and Iron Workups

Area of Science:

• Clinical Laboratory Science
• Healthcare Management
• Health Informatics

Background:

• Laboratory stewardship programs aim to optimize test utilization and patient care.
• Implementation in complex healthcare systems faces challenges.
• Benchmarking metrics are underutilized in laboratory stewardship literature.

Purpose of the Study:

• To develop and pilot benchmarking metrics for laboratory stewardship.
• To address common test utilization issues using easily calculable data.
• To establish optimal benchmarks through inter-laboratory comparisons.

Main Methods:

• The PLUGS Informatics Working Group developed guidelines and metrics.
• Pilot study focused on vitamin D, thyroid, and iron workup test orders.
• Institutions analyzed their own data against established benchmarks.

Main Results:

• Established benchmarks: 50:1 for vitamin D (25-hydroxyvitamin D to 1,25-dihydroxyvitamin D), 3.5:1 for thyroid (TSH to FT4), and 50% for iron workup.
• Nine labs evaluated vitamin D, nine thyroid, and seven iron workups.
• Intervention guidelines were provided for labs below benchmarks.

Conclusions:

• Benchmarking metrics offer a standardized approach to assess and improve test utilization.
• Refinement of benchmarking methodologies is crucial for maximizing stewardship program impact.
• Enhanced laboratory stewardship improves patient safety and resource utilization.