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ASH acknowledges three Choosing Wisely Champions
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ATLANTA — ASH recognized three clinicians who have implemented successful Choosing Wisely projects that improved the quality of care at their institutions during the society’s Annual Meeting and Exposition.
The American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign is designed to reduce unnecessary expenses without sacrificing quality care. The goal is to encourage patient-provider conversations about the necessity and potential harm of certain procedures.
“We all know one of the big challenges in this space is taking an idea and awareness and turning it into real action; that is the challenge for the whole Choosing Wisely initiative,” Lisa K. Hicks, MD, MSc, hematologist at St. Michael’s Hospital and University of Toronto and chair of the ASH Choosing Wisely Task Force, said during the ASH Choosing Wisely Champions session. “We want to use this as an opportunity not just to award them for their outstanding work, but to give them an opportunity to share their work with a larger audience. We hope we will inspire some members, particularly trainees, to take on this type of work, perhaps to build on this work, or to use some of the methodologies to address other opportunities.”
Since 2013, ASH has issued 15 evidence-based recommendations about certain tests, treatments and procedures in hematology that should be questioned in some cases.
As part of ABIM’s new Choosing Wisely Champions initiative, ASH honored three clinicians whose work specifically advances the ideals of Choosing Wisely:
These three clinicians include:
- Matthew Schefft, DO, assistant professor at Children’s Hospital of Richmond at Virginia Commonwealth University — Schefft and colleagues created individualized pain plans to reduce ED admission rates by 20% among children with sickle cell disease. The researchers measured the presence of an individualized pain plan, adherence to the plan, time to first and second opiate dose administration, and other measures, among children with sickle cell disease presenting with vaso-occlusive crisis at Virginia Commonwealth pediatric ED. After 6 months of implementation, researchers observed a 27% reduction in admission rate. Shorter time to second opiate dosing also appeared to be associated with a reduced risk for admission.
“As next steps, we are starting to implement intranasal fentanyl to decrease time to second opiate; we will continue to identify high utilizers, reduce ED utilization and readmission rates with better home pain plans, and disseminate pain plans to community hospitals,” Schefft said during his presentation.
- Yulia Lin, MD, FRCPC, assistant professor in the department of clinical pathology at Sunnybrook Health Science Centre in Toronto, Canada — Lin and colleagues wanted to improve management of iron deficiency anemia by better usage of oral and IV iron over red blood cell transfusion. A baseline, audit determined only 53% of all patients transfused for iron deficiency anemia were deemed appropriate candidates for transfusion as a first-line measure of treatment. The audit further confirmed iron supplementation was not used frequently. To address these issues, the researchers implemented a series of interventions, including creating an education session for ED physicians, making IV iron more available in the ED, developing an algorithm on iron deficiency management for the ED, improving access to transfusion specialist for guidance, and implementing a toolkit for ED physicians. As a result of the interventions, red blood cell transfusion appropriateness improved from 53% to 91% between January 2014 and December 2015.
“Improved red blood cell transfusion appropriateness for iron deficiency anemia in the ED can be achieved and maintained with the implementation of simple educational and practical interventions,” Lin said during the session.
- Marc Stuart Zumberg, MD, section chief for benign hematology at University of Florida Health — Zumberg and colleagues sought to improve blood product utilization after their hospital experienced numerous instances of off-label use of recombinant factor VIIa, prothrombin complex concentrates and blood products. The researchers developed institutionally approved indications for use of the products and guidelines for immediate reversal of anticoagulant-related bleeding for patients on anticoagulants needing emergency surgery. Over 3 years, the project accounted for adjusted reductions of $590,830 for expenditures associated with factor VIIa and prothrombin complex concentrates outside of pharmacy and therapeutics committee-approved criteria for use.
“At this year's Choosing Wisely Session, we [showcased] three outstanding initiatives that tackle different types of overutilization with strategies that are elegant in their relative simplicity,” Hicks said in a press release. “It is our hope that members of the ASH community will be inspired by these projects to address overutilization in their own health care settings.” – by Melinda Stevens
Reference:
ASH Choosing Wisely Campaign: 2017 ASH Choosing Wisely Champions. Presented at: ASH Annual Meeting and Exposition; Dec. 9-12, 2017; Atlanta.
Disclosures: Hicks reports research funding from Gilead.