The American Society of Hematology (ASH) recognized three Choosing Wisely Champions—individuals working to tackle the overuse of hematology tests and treatments—at the 63rd ASH Annual Meeting & Exposition, held December 11–14 in Atlanta.
Choosing Wisely is an initiative that seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments, and procedures. As a part of this initiative, ASH has identified 15 commonly used tests, treatments, and procedures that clinicians and patients should question in certain circumstances to avoid overuse, waste, and harm. The Choosing Wisely Champions campaign recognizes clinicians who have implemented successful projects and provides medical professionals with opportunities to learn about how these projects might be translated to their own practices.
The 2021 ASH Choosing Wisely Champions
• Matthew T. McEvoy, MD, of Texas Children’s Hospital, Houston: “A Risk-Adapted Approach to Reduce Variability and Optimize Management for Pediatric Nutritional Iron-Deficiency Anemia in the Emergency Department”
Matthew T. McEvoy, MD
Dr. McEvoy and colleagues saw that emergency departments lacked a consistent approach to managing care among children younger than 5 who were admitted for iron-deficiency anemia. To standardize and improve care for these patients, Dr. McEvoy and colleagues created a novel clinical algorithm accounting for risk based on anemia severity. Use of the algorithm led to an increase in several outcome quality measures.
• Thomas Bodley, MD, of Sunnybrook Health Sciences Center, Toronto: “Reducing Unnecessary and Repetitive Diagnostic Phlebotomy in an Intensive Care Unit: A Quality Improvement Study”
Thomas Bodley, MD
In the intensive care unit (ICU), blood testing is an essential component of diagnosis, monitoring, and treatment. However, many ICU blood tests are reflexive and unnecessary, and blood loss from repeated blood tests can cause those in the ICU to need red blood cell transfusions, develop ICU-acquired anemia, or require extended stays in the hospital. Dr. Bodley and colleagues successfully implemented a series of strategies that reduced the amount of blood taken from patients each day and lowered the number of discrete blood draws per patient per day.
• Srila Gopal, MD, of the University of California, San Diego: “Establishing Same-Day Infusion Treatment Protocols for Uncomplicated Sickle Cell Vaso-occlusive Crises Using a Telemedicine Platform”
Srila Gopal, MD
Individuals living with sickle cell disease experience vaso-occlusive crises, common and painful complications that occur when sickled cells cluster together and obstruct blood flow. An individual with sickle cell disease may seek care in the emergency department for vaso-occlusive crises, but early, adequate treatment of pain in an outpatient-based infusion center setting is key to avoiding hospital visits. During the COVID-19 pandemic–related shutdowns, Dr. Gopal and colleagues recognized they would need an alternate way to ensure these patients received their necessary care. They created a telemedicine platform to continue infusion center treatment with a multidisciplinary team of providers. After implementation of the telemedicine approach, infusion center visits increased and emergency department visits decreased.