Blood Tests, Thyroid Function Testing, and LVC

Reducing full iron panels when a single test will do

Why is it low-value care?

Iron studies are often ordered in the investigation of iron deficiency anaemia. Iron studies comprises three separate tests with one calculation. Interpretation of iron studies is nuanced and serum iron in particular reflects dietary intake over the past 24 hours rather than body stores. Low serum iron often leads to over-diagnosis of iron deficiency. The most reliable test in the absence of inflammation is ferritin. Ferritin requires less blood and is half the cost.

Our recommendation is that ferritin alone is ordered for the investigation of iron deficiency anaemia. Our target rate is less than 30 per cent of total investigations for iron deficiency to be iron studies.

What were we doing?

During the initial data collection period from January to March 2018, of all orders for ferritin and iron studies, 57 per cent had iron studies completed and 43 per cent ferritin (2573 presentations).

What interventions have been introduced?

One of the key drivers identified was lack of knowledge. Most ordering physicians were not aware that this was their default practice and agreed with the recommendation to change. With that being the case, education for clinicians was the primary intervention and included emails to Heads of Department and department meetings, especially for the top 10 ordering departments.

How effective have we been?

At the end of this project, we achieved a rate of 24 per cent, exceeding our target of less than 30 per cent. We have now converted to a sustainability model to regularly monitor this rate and ensure it is maintained.

Reducing full thyroid function testing when unnecessary

(coming soon)