Background

Laboratory testing is the most common medical activity in Canada; an estimated CAD $5.9 billion is spent on laboratory activities annually.¹ Laboratory test overuse occurs when tests are ordered inappropriately, without due consideration of impact on clinical status. An estimated 16–56% of laboratory testing provides no clinical value in improving patient care.¹ Laboratory test overuse is associated with preventable patient harm, further unnecessary tests and procedures related to false positive results, inappropriate resource utilization, and health care system costs.^2–7

Recognizing the health significance of laboratory test overuse, Choosing Wisely Canada, a campaign to reduce unnecessary tests and treatments, has recently launched the ‘Using Labs Wisely’ initiative.⁸ Thyroid testing in particular, is the focus of multiple Choosing Wisely Canada recommendations.⁹ Thyroid tests are highly utilized tests in both inpatient and outpatient settings.¹⁰ Local data from British Columbia (BC) shows that thyroid testing has been rising in the past decade, standardized for population growth.

With support from UBC Faculty of Medicine’s Strategic Investment Fund, UBC CPD is working together with UBC Therapeutics Initiative and Dr. Anshula Ambasta, Department of Anesthesiology, Pharmacology and Therapeutics to develop education for health care practitioners and tools to engage patients in shared decision-making that support appropriate and optimal utilization of thyroid testing.

Process

Starting with a needs assessment, we hope to gain a better understanding of the perspectives that BC healthcare practitioners have on thyroid testing, with a focus on the following tests: thyroid stimulating hormone (TSH), free thyroxine4 (FT4), free thyroxine3 (FT3) and anti-TPO antibody.

Through survey results and subsequent focus group sessions and systematic literature reviews, we hope to identify barriers and facilitators regarding optimal use of thyroid testing, help create system design changes, and develop resources for health care practitioners.

Solution

We intend to use needs assessment results to help inform the design and development of the education. Check back here for more updates as we continue our design process.

Expected launch: August 2024. Sign up for our newsletter to be notified when education is available.

References

1. Naugler C, Wyonch, R. What the Doctor Ordered: Improving the Use and Value of Laboratory Testing. 2019 Feb 14, 2019. https://www.cdhowe.org/public-policy-research/what-doctor-ordered-impro… (accessed October 4, 2019).
2. Salisbury AC, Reid KJ, Alexander KP, et al. Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction. Archives of internal medicine 2011;171(18):1646-53. doi: 10.1001/archinternmed.2011.361 [published Online First: 2011/08/10]
3. Thavendiranathan P, Bagai A, Ebidia A, et al. Do blood tests cause anemia in hospitalized patients? The effect of diagnostic phlebotomy on hemoglobin and hematocrit levels. Journal of general internal medicine 2005;20(6):520-4. doi: 10.1111/j.1525-1497.2005.0094.x [published Online First: 2005/07/01]
4. Koch CG, Li L, Sun Z, et al. Hospital-acquired anemia: prevalence, outcomes, and healthcare implications. J Hosp Med 2013;8(9):506-12. doi: 10.1002/jhm.2061 [published Online First: 2013/07/23]
5. Houben PH, Winkens RA, van der Weijden T, et al. Reasons for ordering laboratory tests and relationship with frequency of abnormal results. Scandinavian journal of primary health care 2010;28(1):18-23. doi: 10.3109/02813430903281758 [published Online First: 2010/02/04]
6. Bruce CR, Fetter JE, Blumenthal-Barby JS. Cascade effects in critical care medicine: a call for practice changes. American journal of respiratory and critical care medicine 2013;188(12):1384-5. doi: 10.1164/rccm.201309-1606ED [published Online First: 2013/12/18]
7. Ganguli I, Lupo C, Mainor AJ, et al. Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries. JAMA Intern Med 2019;179(9):1211-19. doi: 10.1001/jamainternmed.2019.1739 [published Online First: 2019/06/04]
8. Canada CW. Using Labs wisely during global blood tube and other resource shortages Canada: Choosing Wisely Canada. ; 2022 [Available from: https://choosingwiselycanada.org/perspective/global-shortages/ accessed February 24 2022.
9. Choosing Wisely Canada Recommendations Canada: Choosing Wisely Canada; 2017 [Available from: https://choosingwiselycanada.org/recommendations/ accessed Nov 14, 2017 2017.
10. Ma I, Guo M, Lau CK, et al. Test volume data for 51 most commonly ordered laboratory tests in Calgary, Alberta, Canada. Data in brief 2019;23:103748. doi: 10.1016/j.dib.2019.103748 [published Online First: 2019/08/03]