J Pediatr 2021 May 11. Epub 2021 May 11.
Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Department of Pediatrics, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8; Department of Physiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8.
Objectives: To promote resource stewardship in thyroid hormone testing at a pediatric tertiary care hospital.
Study Design: Quality improvement approaches generated three change ideas that were implemented simultaneously in the hospital electronic medical record (EMR): (1) a reflex free thyroxine (fT4), whereby fT4 is automatically reported if the thyroid stimulating hormone (TSH) is outside the normal range; (2) a forced-function for thyroid hormone ordering, whereby a provider must select an appropriate indication for ordering fT4 or triiodothyronine (T3); and (3) a clinical decision support message displayed at the time of ordering thyroid function tests. Laboratory data were audited to determine the mean number of fT4 and T3 tests performed per week as well as indications for testing. Read More