Routine T4 No More? Reducing Excess Thyroid Hormone Testing at a Pediatric Tertiary Care Hospital

Abitbol, L; Tenedero, Christine Bernice; Sepiashvili, Lusia; Wasserman, Jonathan D.; Palmert, Mark R.

doi:10.1016/j.jpeds.2021.05.010

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…There are many different situations in which an application program, rather than a human, can create an entry in the audit log. For example, there are several laboratory tests that a clinical decision support program can automatically “order” based on the results of another test (e.g., Thyroid Stimulating Hormone (TSH level followed by Free T4 or Free T3) 33 . These tests are referred to as reflex tests.…”

Section: What Are Some Common Audit Log‐related Problems?mentioning

confidence: 99%

A guide to mitigating audit log‐related risk in medical professional liability cases

Sittig¹,

Wright

2023

J of Healthc Risk Manag

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Following the American Recovery and Reinvestment Act in 2009, use of electronic health records (EHRs) has become ubiquitous. Accordingly, one should expect most medical professional liability cases to involve review of patient records produced from EHRs. When questions arise regarding who was involved in care of a patient, what they knew and when, or the meaning, completeness, integrity, validity, timeliness, confidentiality, accuracy, or legitimacy of data, or ways that the EHR's user interface or automated clinical decision support tools may have contributed to the alleged events, one often turns to the EHR and its audit log. This manuscript discusses lines of defense incorporated into the design, development, implementation, and use of EHRs to ensure their integrity and the types of EHR transaction logs (e.g., audit log) that exist. Using these logs can help one answer questions that often arise in medical malpractice cases. Finally, there are “best practices” surrounding EHR audit logs that health care organizations should implement. When used appropriately, EHRs and their audit logs provide another source of information to help hospital risk managers, legal counsel, and EHR expert witnesses to investigate adverse incidents and, if needed, prosecute or defend clinicians and/or health care organizations involved in the patient's care.

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Section: What Are Some Common Audit Log‐related Problems?mentioning

confidence: 99%

A guide to mitigating audit log‐related risk in medical professional liability cases

Sittig¹,

Wright

2023

J of Healthc Risk Manag

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Identifying Region-Specific Allergy Sensitization Clusters to Optimize Diagnosis and Reduce Costs

Oezguen,

Rider,

Dowlin

et al. 2024

The Journal of Pediatrics

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Resource stewardship and Choosing Wisely in a children’s hospital

Friedman

Whitney

Jones

et al. 2022

Paediatrics &Amp; Child Health

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Objectives Evidence suggests that approximately 30% of the tests and treatments currently prescribed in healthcare are potentially unnecessary, may not add value, and in some cases cause harm. We describe the evolution of our hospital’s Choosing Wisely (CW) program over the first 5 years of existence, highlighting the enablers, challenges, and overall lessons learned with the goal of informing other healthcare providers about implementing resource stewardship initiatives in paediatric healthcare settings. Methods We describe the development of de novo “top 5” CW lists of recommendations using anonymous surveys and Likert scale scoring. Composition and role of the steering committee, measurement of data and outcomes, and implementation strategies are outlined. Results Many projects have resulted in a successful decrease in inappropriate utilization while simultaneously monitoring for unintended consequences. Examples include respiratory viral testing in the emergency department (ED) decreased by greater than 80%; ankle radiographs for children with ankle injuries decreased from 88% to 54%; and use of IVIG for treatment of typical ITP cases decreased from 88% to 55%. Early involvement focused within General Paediatrics and the ED, but later expanded to include perioperative services and paediatric subspecialties. Conclusions An internally developed CW program in a children’s hospital can reduce targeted areas of potentially unnecessary tests and treatments. Enablers include credible clinician champions, organizational leadership support, reliable measurement strategies, and dedicated resource stewardship education. The lessons learned may be generalizable to other paediatric healthcare settings and providers looking to introduce a similar approach to target unnecessary care in their own organizations.

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Routine T4 No More? Reducing Excess Thyroid Hormone Testing at a Pediatric Tertiary Care Hospital

Cited by 4 publications

References 21 publications

A guide to mitigating audit log‐related risk in medical professional liability cases

A guide to mitigating audit log‐related risk in medical professional liability cases

Identifying Region-Specific Allergy Sensitization Clusters to Optimize Diagnosis and Reduce Costs

Resource stewardship and Choosing Wisely in a children’s hospital

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