The American Society of Hematology (ASH) recognized three Choosing Wisely Champions, practitioners working to tackle overuse of hematology tests and treatments, at the all-virtual 2020 ASH Annual Meeting & Exposition.
Choosing Wisely, a program of the ABIM Foundation and Consumer Reports, aims to prompt conversations between patients and clinicians about the necessity and potential harm of certain procedures. As a part of this initiative, ASH has identified 15 commonly used tests, treatments, and proceduresin hematology that clinicians and patients should question in certain circumstances to avoid overuse, waste, and harm. Choosing Wisely Champions recognizes clinicians who have implemented successful projects to improve quality at their institutions and advance the goals of the campaign.
The names and research focus of the 2020 ASH Choosing Wisely Champions follow:
Sriman Swarup, MD, Texas Tech University Health Sciences Center, Lubbock: “A Restructured Approach to the Diagnosis of Heparin-Induced Thrombocytopenia.” Dr. Swarup and colleagues examined data over 1 year to understand how often clinicians at their large tertiary academic hospital
Sriman Swarup, MD
ordered the 4T screening pretest before ordering the heparin-induced thrombocytopenia screening antibody test. It was determined that the latter was outdated, and so it was replaced with a new test. At 6 months postintervention, this innovation led to improved use of the 4T scoring system—which translated to reductions in inpatient stay, use of alternative anticoagulation, and health-care expenditures in the target population.
Hind Salama, MD, Oncology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia: “Reducing Futile Acute Care Services for Terminally Ill Cancer Patients: The Dignity Project.” The Dignity Project is a quality improvement project intended to reduce the unnecessary use of acute care services for patients with cancer treated with a palliative-intent approach. The project was carried out in three phases: a preintervention phase to assess the magnitude of the problem, an intervention model to improve the practice, and a postintervention phase to assess the outcome of the intervention model. Following the intervention period, timely documentation of goal of care has improved from 59% to 83% and intensive care admission had decreased from 26% to 12% in the preintervention and postintervention phases, respectively. This resulted in an annual cost savings of $601,200.
Arielle L. Langer, MD, MPH, Brigham and Women’s Hospital, Boston: “Reducing Unnecessary Thrombophilia Testing.” Dr. Langer and colleagues were concerned that positive test results could lead to excessive anticoagulation and that negative results could lead to withholding of needed anticoagulation. After their intervention, there was a 17.1% reduction in overall testing (P = .007). The greatest reduction was in the outpatient practices of the hematology/oncology division, which showed a 45.9% reduction (P = .007). Due to the high cost of these tests, the reduction in testing resulted in a savings of $31,626.82 per month without compromising patient care.