Reducing free thyroid hormone testing through multiple Plan-Do-Study-Act cycles

Taher, Jennifer; Beriault, Daniel; Yip, Drake; Tahir, Shafqat; Hicks, Lisa K.; Gilmour, Julie

doi:10.1016/j.clinbiochem.2020.05.004

Cited by 11 publications

(7 citation statements)

References 13 publications

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“…One study shows that 39% of free T4 and 47% of free T3 orders were unnecessary as the TSH results were within the reference interval. 58 Choosing Wisely Canada has recommended the implementation of a thyroid reflex algorithm to help reduce unnecessary free T4 and free T3 ordering. 59 Recommendation 5 Don't request a serum protein electrophoresis in asymptomatic patients without unexplained hypercalcemia, renal insufficiency, anemia, or lytic bone lesions-Canadian Association of Medical Biochemists, 2020.…”

Section: Rationalementioning

confidence: 99%

Reduce, Reuse, Recycle: Top 10 Choosing Wisely Canada’s Recommendations for Conserving Laboratory Resources

Beriault

Rodríguez-Capote

Hauff

et al. 2022

Can Journ Gen Int Med

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The COVID-19 pandemic has significantly impacted the production, distribution, and demand of essential laboratory supplies worldwide. In 2021, severe shortages in required laboratory supplies such as blood collection tubes, butterfly needles, and blood gas syringes became a critical issue across Canada. Many hospitals or institutions had to instruct physicians and patients to limit laboratory testing where possible and, in some cases, required emergency shipments of tubes from alternative vendors or nearby hospitals. Laboratory testing is ubiquitous in managing patients. It is used for screening, diagnosis, and monitoring purposes. With limited blood collection tubes, consideration for restricting non-urgent testing is needed to conserve supply and protect acute care departments that manage critically ill patients. In addition, laboratories across Canada have experienced significant staffing shortages, resulting in an even greater need for appropriate laboratory utilization. Consequently, the Canadian Society of Clinical Chemists (CSCC) and the Canadian Association of Medical Biochemists (CAMB) curated utilization recommendations for both hospital and primary care settings in collaboration with Choosing Wisely Canada (CWC). These recommendations were specifically selected from those previously published by Choosing Wisely Canada (CWC), with impact statements and rationales added to conserve at-risk laboratory resources. Supply chain disruptions of clinical laboratory resources are expected to continue throughout 2022, indicating that now, more than ever, a focus on appropriate laboratory utilization is essential. RésuméLa pandémie de COVID-19 a eu un impact considérable sur la production, la distribution et la demande de fournitures de laboratoire essentielles dans le monde entier. À partir de 2021, de graves pénuries de fournitures de laboratoire essentielles, comme les tubes pour prélèvement sanguin, les aiguilles à ailettes et les seringues pour l’analyse de gaz sanguin, sont devenues un question cruciale au Canada. De nombreux hôpitaux et étab-lissements ont dû demander aux médecins et aux patients de limiter dans la mesure du possible les analyses en laboratoire et, dans certains cas, ont eu besoin qu’on leur envoie d’urgence des tubes provenant d’autres fournis-seurs ou d’hôpitaux voisins. Les analyses en laboratoire sont omniprésentes dans la prise en charge des patients et sont utilisées à des fins de dépistage, de diagnostic et de suivi. Étant donné le nombre limité de tubes pour prélèvement sanguin, il faut envisager de restreindre les analyses non urgentes pour conserver les réserves et protéger les services de soins de courte durée qui prennent en charge les patients gravement malades. De plus, partout au Canada, les laboratoires connaissent des pénuries importantes de personnel, ce qui rend encore plus nécessaire une utilisation appropriée des laboratoires. Par conséquent, la Société canadienne des clini-co-chimistes (SCCC) et l’Association des médecins biochimistes du Canada (CAMB), en collaboration avec Choisir avec soin (CAS), ont préparé des recommandations d’utilisation pour les milieux hospitaliers et de soins de santé primaires. Ces recommandations ont été spécifiquement choisies à partir de celles déjà publiées par CAS, en y ajoutant des énoncés des répercussions et des justifications, et visent à conserver les ressources de laboratoire à risque. On s’attend à ce que les perturbations de la chaîne d’approvisionnement en ressources de laboratoire clinique se poursuivent tout au long de l’année 2022, ce qui indique que maintenant, plus que jamais, il est essentiel de se concentrer sur une utilisation appropriée des laboratoires.

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Section: Rationalementioning

confidence: 99%

Reduce, Reuse, Recycle: Top 10 Choosing Wisely Canada’s Recommendations for Conserving Laboratory Resources

Beriault

Rodríguez-Capote

Hauff

et al. 2022

Can Journ Gen Int Med

View full text Add to dashboard Cite

show abstract

“…Many studies combine several tools [ 14 , 17 , 19 ], which has been shown to have an additive effect on the overall outcome [ 20 ]. In addition, the collaboration of laboratory specialists and clinicians together with audits, feedbacks, reminders and multiple plan-do-study-act (PDSA) cycles will further improve efficiency in terms of a continuous improvement process [ 12 , 14 , 18 , 19 ].…”

Section: Possible Strategies To Avoid Inappropriate Test Utilizationmentioning

confidence: 99%

“…In general, reflex testing may be used to prevent over- as well as underutilization. For example, reflex testing may be suitable for the stepwise analysis of thyroid hormones, where thyroid-stimulating hormone (TSH) is the initial test, and subsequent analysis of free thyroid hormones should only be performed in the case of abnormal TSH results [ 18 , 19 , 42 ]. By implementing this reflex, subsequent tests cannot be missed (preventing underutilization), and clinicians do not have to order all tests at once, which would be a source of overutilization.…”

Section: Possible Strategies To Avoid Inappropriate Test Utilizationmentioning

confidence: 99%

“…Furthermore, two studies address the important topic of quality improvement and balancing measures. In the study of Taher et al [ 18 ], continuous data monitoring and collaboration with clinicians resulted in improvements of the TSH reflex algorithm through two PDSA cycles. Gilmour et al [ 19 ] accompanied the two-stage process by a root cause analysis, feedback through a survey and baseline data analysis to evaluate potentially missed diagnoses after the implementation of the reflex system.…”

Section: Possible Strategies To Avoid Inappropriate Test Utilizationmentioning

confidence: 99%

“…Lack of knowledge, insecurity, pure habit, patient pressure or fear of lawsuits are possible causes for inappropriate testing [ 13 , 14 , 15 ]. The lack of knowledge is reflected by various studies, which observed inappropriate orders despite available guidelines or recommendations on the implementation of demand management (DM) tools [ 12 , 14 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Laboratory Demand Management Strategies—An Overview

et al. 2021

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Inappropriate laboratory test selection in the form of overutilization as well as underutilization frequently occurs despite available guidelines. There is broad approval among laboratory specialists as well as clinicians that demand management strategies are useful tools to avoid this issue. Most of these tools are based on automated algorithms or other types of machine learning. This review summarizes the available demand management strategies that may be adopted to local settings. We believe that artificial intelligence may help to further improve these available tools.

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