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ASH recognizes three Choosing Wisely champions
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SAN DIEGO — ASH honored three practitioners as Choosing Wisely champions at ASH Annual Meeting and Exhibition for successfully implementing programs at their institutions that reduced the use of unneeded hematology tests and treatments.
The American Board of Internal Medicine Foundation’s Choosing Wisely campaign aims to reduce expenses without decreasing quality of care. It also encourages conversations between patients and doctors about the necessity and potential harm of certain procedures.
“Each year we highlight three Choosing Wisely champions who have a successful quality improvement project that addresses overutilization that are really in the spirit of the Choosing Wisely campaign,” Anita Rajasekhar, MD, associate professor of medicine at University of Florida and co-chair of the ASH subcommittee on stewardship and systems-based hematology, told HemOnc Today. “This year we had three unique projects that really did bring change to their institutions.”
The three practitioners chosen for awards included:
- Adam F. Binder, MD, physician at Thomas Jefferson University Sidney Kimmel Cancer Center
Binder and colleagues developed an institutional algorithm at Montefiore Medical Center in New York that helps guide the appropriate use of IV vancomycin. Binder and colleagues began working on this algorithm after a preliminary review of antibiotic use at Montefiore showed that doctors were overprescribing vancomycin based on existing guidelines. After implementing the algorithm, appropriate prescribing of the drug increased to 66% from 49%.
“It’s an honor to have our work recognized here. I think it’s important that ASH is recognizing process improvement and quality improvement in the way we practice medicine on a daily basis,” Binder told HemOnc Today. “It highlights the need of doing things better with the established evidence that we already have.”
- Ming Lim, MD, of Medical University of South Carolina
Lim and colleagues implemented a hospital-wide protocol that coordinated testing and treatment of patients with heparin-induced thrombocytopenia (HIT). Lim and colleagues began this project after they discovered many patients at their institution were being tested for HIT despite having low probabilities of having the disease based on their 4T score. Only a minority of patients who tested positive on the platelet-factor four enzyme-linked immunosorbent assay underwent confirmation with the serotonin-release assay. Also, patients received nonheparin anticoagulants needlessly before the results of the serotonin-release assay were available.
The implementation of the protocol created by Lim and colleagues improved the testing and treatment of patients with HIT and lowered the use of nonheparin anticoagulants by 78%.
“Having our program recognized really means we’ve done important work that has changed patients lives and improved the quality of care and cost of care for our hospital, Charles Greenberg, MD, who was part of the team and accepted the award on behalf on Lim, told HemOnc Today. “Hopefully we will be able to use this to further emphasize to our institution the importance of our discipline, because it’s a discipline that’s under strain to survive without showing value.”
- Prakash Vi shnu, MD, hematologist and internist at Mayo Clinic in Jacksonville, Florida
Vishnu and colleagues evaluated how to reduce the number of blood transfusions for patients undergoing myeloablative chemotherapy and autologous hematopoietic stem cell rescue who didn’t them.
Researchers transfused one unit of red blood cells to the patients instead of two. Results showed a decrease of the amount of red blood cell units transfused from 71 in 2016 to 28 in 2017. There was no difference in the time of engraftment between patients who received the extra red blood cells and those who didn’t. Also, the incidence of sepsis was nearly 20% higher in patients who got the extra red blood cells compared with those who didn’t.
“It’s really satisfying because blood is not something we can synthesize. It’s completely natural and it’s based on good Samaritans who decided to give blood,” Vishnu told HemOnc Today. “There’s also enough data that show there is more harm giving extra blood. So, it’s a win-win situation, because you are conserving blood and not harming the patient.”– by John DeRosier
Reference:
ASH Choosing Wisely Campaign: 2018 ASH Choosing Wisely Champions. Presented at: ASH Annual Meeting and Exposition; Dec. 1-4, 2018; San Diego.
Disclosures : Binder, Greenberg, Lim, Rajasekhar and Vishnu report no relevant financial disclosures.