■游离甲状腺素(fT4)通常在未指示时订购。当前研究的目标是使用质量改进工具来识别和实施最佳方法,以减少整个大型儿科医院系统中不适当的fT4测试。
■在审查了基于证据的指南和最佳实践之后,具有fT4测试反射的促甲状腺激素和在订单输入时具有临床决策支持的门诊甲状腺订单面板,以及几轮提供者的教育和反馈,已实施。与主题专家一起审查了门诊和住院医嘱集以及系统偏好列表,并在适当时进行了修订。确定了跟踪指标。使用从电子健康记录中检索的数据创建了自动的每月运行图和统计过程控制图。建立基准数据的图表,平衡测量数据,监测干预措施的影响,并确定了未来的干预措施。
■在44个月的时间里,在非内分泌学提供者中,在住院和门诊患者中,fT4和促甲状腺激素联合用药从67%降低至15%,fT4反射检测从0%升高至77%.在3年内减少5179个fT4测试的直接成本节省被确定为$45800。
■执行反射fT4测试后,具有临床决策支持的新型订单小组,提供者教育,并更改订购模式,在非内分泌学提供者中,fT4测试大幅且可持续地减少,这与显著的成本节约相关.
BACKGROUND: Free thyroxine (fT4) is often ordered when not indicated. The goal of the current study was to use quality improvement tools to identify and implement an optimal approach to reduce inappropriate fT4 testing throughout a large pediatric hospital system.
METHODS: After reviewing evidence-based
guidelines and best practices, a thyroid-stimulating hormone with reflex to fT4 test and an outpatient thyroid order panel with clinical decision support at order entry, along with several rounds of provider education and feedback, were implemented. Outpatient and inpatient order sets and system preference lists were reviewed with subject matter experts and revised when appropriate. Tracking metrics were identified. Automated monthly run charts and statistical process control charts were created using data retrieved from the electronic health record. Charts established baseline data, balancing measure data, monitored the impact of interventions, and identified future interventions.
RESULTS: Over a 44-month period, among nonendocrinology providers, a reduction in fT4 and thyroid-stimulating hormone co-orders from 67% to 15% and an increase in reflex fT4 tests from 0% to 77% was obtained in inpatient and outpatient settings. Direct cost savings as a result of performing 5179 fewer fT4 tests over 3 years was determined to be $45 800.
CONCLUSIONS: After implementation of a reflex fT4 test, a novel order panel with clinical decision support, provider education, and changes to ordering modes, a large and sustainable reduction in fT4 tests that was associated with significant cost savings was achieved among nonendocrinology providers.