To determine the effectiveness of different interventions to reduce unnecessary requests of serum thyroid stimulating hormone levels in a hospital.

Abstract

Objective: To reduce unnecessary requests for Serum Thyroid stimulating hormone (TSH) levels in a hospital setting using targeted interventions. Study Design: Interventional study. Setting: Najran Armed Forces Hospital (NAFH), Saudi Arabia. Period: January 2019 to June 2020. Material & Methods: Sampling technique was non probability convenient sampling and included all the TSH requests received in the laboratory. The tests were categorized into three categories e.g., repeated requests within one month, requests as routine investigation and requests not related to diagnosis. The interventions made included the initiation of hospital guidelines, resolving the limitations of Laboratory information system (LIS) and increasing awareness of physicians. The effectiveness of interventions was calculated by measuring the number of unnecessary requests out of total number of TSH requests. The comparison was made between problem identification phase and post implementation phase. Results: The analysis of data showed a reduction in the routine unnecessary TSH requests by almost 11%. During the first half of 2019(Jan -July) total number of TSH tests were 5713 with 3427 (60%) unnecessary requests. After initiation and implementation of interventions the unnecessary requests reduced by 11% during Jan-July 2020. There were only 1857(49%) unnecessary requests out of total 3827 TSH tests. These results were statistically significant with p-value of less than 0.05. Conclusion: The application of appropriate interventions decreased the unnecessary requests of TSH. This reduction in turn reduced the wastage of the cost spent and the workload implied on staff for processing these unnecessary requests.