The American Society of Hematology (ASH) recently became the newest specialty society to recognize Choosing Wisely Champions—clinicians who are working to address overuse of tests and treatments. ASH announced the following Choosing Wisely Champions at its 58th annual meeting in San Diego earlier this month:
Maria Juarez, MD, Baylor Scott & White Health, Cancer Institute of Dallas, Texas – To combat variability in blood utilization across Baylor Scott & White Health’s hospitals (encompassing 133,550 patients), Dr. Juarez and her colleagues developed an institutional clinical practice recommendation, modified transfusion workflow in the electronic health record (EHR), and launched an educational campaign (“Why Give 2 When 1 Will Do?”). With these collective interventions, the number of single-unit transfusions increased by approximately 17 percent during the program period. Single-unit transfusions are now the predominant red blood cell transfusion order, comprising nearly 57 percent of all red blood cell transfusion orders in the hospital system. Documentation of hemoglobin levels prior to transfusion also improved.
Javier Munoz, MD, MS, FACP, Banner MD Anderson Cancer Center, Gilbert, Arizona – To avoid potential harm from over-testing patients, Dr. Munoz and his colleagues implemented an intervention designed to test whether an automatic alert in an EHR could remind clinicians to carefully weigh the anticipated benefits against the risks of post-treatment imaging scans for patients with lymphoma. Though the study is ongoing, the automatic alert has reduced the overall number of imaging studies from 48.3 to 25.3 scans per month. Dr. Munoz is trying to transition efforts from relapse detection based solely on imaging to improved survivorship with a more conscientious use of resources. He is in the process of expanding this project to all Banner Healthcare system sites.
Ravi Sarode, MD, UT Southwestern Medical Center, Dallas, Texas – Dr. Sarode and his colleagues discovered that approximately 85 percent of thrombophilia tests at UT Southwestern’s two teaching hospitals were ordered incorrectly or incompletely. Thrombophilia tests are frequently ordered (usually by non-hematologists) for patients with acute thrombotic events, often while the patient is on anticoagulation therapy; however, sometimes additional variables can cause these standard tests to return false positive results. These abnormal results are not always checked for reproducibility or accuracy, causing some patients to be inappropriately placed on long-term anticoagulation therapy. To promote appropriate use of testing, Dr. Sarode’s team developed local guidelines and implemented them in the EHR via a series of cascading questions that providers must answer before ordering tests. After implementation of the intervention and an associated education campaign, UT Southwestern has reduced thrombophilia testing for inpatients in the university hospital by more than 90 percent.
The ASH Choosing Wisely Champions were selected by an ASH taskforce, and honorees presented their work at a Special-Interest Session at the Annual Meeting, providing attendees with an opportunity to learn about projects that might be translated to their own practices.
“Improving quality in medical practice requires creativity, hard work, dedication, and the ability to question commonplace practices,” said Lisa Hicks, MD, of St. Michael’s Hospital and the University of Toronto and chair of the ASH Choosing Wisely Task Force. “Choosing Wisely Champions is a way for us to honor practitioners who have taken on the challenge of eliminating the unnecessary and potentially harmful hematology tests and treatments at their own institutions. Their success is inspiring, and I have no doubt that they will motivate others to follow their lead.”