Evidence-Based Oncology January 2017
ASH "Choosing Wisely Champions" Share Their Practice-Changing Success
Ravindra Sarode, MD, medical director of clinical laboratory services, University of Texas Southwestern Medical Center, Dallas, Texas, spoke during the session, “Reduction in Unnecessary or Misapplied Thrombophilia Testing in Patients with DVT, PE, or Other Thrombotic Disorders Using Combination of Education and EMR Alerts. “The ASH Choosing Wisely guiding principles aim to reduce harm to patients, reduce costs, and are within the clinical domain of hematology,” Sarode said. For his presentation, Sarode referred to recommendation 2 by ASH:
Don’t test for thrombophilia in adult patients with venous thromboembolism (VTE) occurring in the setting of major transient risk factors (surgery, trauma, or prolonged immobility).1
“Unfortunately, there are no thrombophilia-testing guidelines,” he told the audience. “Why, whom, what, and when to test are always open-ended questions.” Confusion over whether testing should be done in-house and the lack of testing guidelines in the adult and pediatric populations make for complicated decisions on testing.
Unnecessary testing can result in serious harm because of the following:
- Testing is often conducted in provoked venous thromboembolism (VTE) during an acute event of anticoagulation
- VTE testing often yields false-positive results
- Testing often results in an unnecessary increase in healthcare costs
- 70% had VTE or pregnancy loss (34%, unprovoked VTE or >3 pregnancy losses; 35%, provoked VTE; 31%, no documented reason)
- 51% were tested within 7 days of an index clinical event
- 51% were tested on anticoagulation therapy results affected by anticoagulation therapy
- 16% had a complete work-up with 1 work draw
- 84% had incomplete or fragmented testing, including unnecessary blood draws, which was a waste of time for the nurse and the technician
- 46% had abnormal results, and only 46% of these had abnormal tests repeated for confirmation; 54% potentially had a wrong diagnosis with long-term anticoagulation.
Maria I. Juarez, MD, from the Cancer Institute of Dallas, Mansfield, Texas, spoke during “Reduction of RBC Transfusion Via Updated Guidelines, Modified Workflow, and Physician Education.” She detailed the project at their cancer institute that addressed recommendation 1 by ASH: