ASH recognizes three Choosing Wisely Champions
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ASH recognized three Choosing Wisely Champions during the ASH 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.
Through this initiative, ASH identified 15 commonly used hematology treatments, tests and procedures that clinicians and patients should question.
Choosing Wisely champions have implemented successful efforts at their institutions to advance the goals of this effort and improve quality at their institutions.
“Each year [ASH] spotlights Choosing Wisely Champions who lead by example and show that making systemic improvements to enhance the quality of patient care can happen everywhere,” Anita Rajasekhar, MD, a hematologist at University of Florida and chair of the ASH subcommittee on stewardship and systems-based hematology, said in a press release.
This year’s Choosing Wisely Champions are:
• Sriman Swarup, MD, of Texas Tech University Health Sciences Center — Swarup was recognized for helping to develop a restructured approach to the diagnosis of heparin-induced thrombocytopenia.
Swarup and colleagues examined data from their large tertiary academic hospital over a year to understand how often clinicians ordered the 4T screening pretest for heparin-induced thrombocytopenia (HIT) prior to ordering the HIT screening antibody test.
They determined 4T scoring was incorporated into each patient’s electronic medical record and was made a compulsory part of the HIT workup, with post-intervention prevalence noted. They determined the antibody screening test done at the hospital was outdated. They replaced the screening test with a new HIT screening antibody test that helped improve the use of the 4T scoring system, which helped reduce inpatient stays, alternative anticoagulation use and health care expenditures.
• Hind Salama, MD, of King Abdulaziz Medical City in Saudi Arabia — Salama helped implement The Dignity Project, a quality improvement project designed to reduce unnecessary usage of acute care services for patients with cancer treated with a palliative intent approach.
The intervention phase consisted of multidisciplinary meetings to determine and document the treatment goal for each patient; education of staff, patients and their families; mandatory documentation of care goals in the electronic health record; and early palliative care referral.
After these interventions, timely documentation of care goals improved from 59% to 83%, and ICU admission declined from 26% to 12%. This led to an estimated annual cost savings of $601,200.
• Arielle L Langer, MD, MPH, of Brigham and Women’s Hospital — Langer and colleagues aimed to reduce unnecessary thrombophilia testing.
They hypothesized that negative tests might result in withholding of needed anticoagulation and that positive tests may result in result in excessive anticoagulation.
Langer and colleagues developed a consensus testing algorithm and an educational campaign, and they also implemented order sets changes.
Before the intervention, an average 801 low-yield thrombophilia tests occurred each month. The intervention led to a 17.1% reduction in overall testing (P = .007), with the greatest reduction in the hematology/oncology division’s outpatient practices (45.9%; P = .007).
The reduced testing resulted in monthly cost savings of $31,626 without compromising patient care.
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