Choosing Wisely Champions Project Archive
Explore the projects below to learn about successful approaches for eliminating costly and potentially harmful overuse of tests and procedures.
Maria Juarez, MD
Baylor Scott & White Health, Cancer Institute of Dallas
Reduction of RBC Transfusion via Updated Guidelines, Modified Workflow, and Physician Education
To combat variability in blood utilization across hospitals in the Baylor Scott & White Health system, Dr. Maria Juarez and her colleagues developed an institutional clinical practice recommendation based on published red blood cell utilization guidelines, modified transfusion workflow in the electronic health record, and launched a “Why Give 2 When 1 Will Do?” educational campaign. With these collective interventions, the number of single unit transfusions increased by approximately 17 percent during the program period. Single unit transfusions now comprise 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
Banner MD Anderson Cancer Center
Reduction of Post-Treatment Scanning Using EMR Alerts
To avoid potential harm from over-testing patients, Dr. Javier Munoz and his colleagues implemented an electronic medical record intervention designed to test whether the introduction of an automatic alert would remind clinicians to carefully weigh the anticipated benefits versus the risks of post-treatment imaging scans for patients with lymphoma. Although the study is ongoing, the automatic alert has reduced the overall number of imaging studies. The average number of monthly scans fell to 25.3 per month over the course of the first three months of the study versus an average 48.3 scans per month in the eight months prior to the introduction of the intervention.
Ravindra Sarode, MD
University of Texas Southwestern Medical Center
Reduction in Unnecessary or Misapplied Thrombophilia Testing in Patients with DVT, PE, or Other Thrombotic Disorders Using Combination of Education and EMR Alerts
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. Sometimes, additional variables can cause these tests to return false positive results, which 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 electronic medical record requiring providers to answer a series of cascading questions before ordering tests. After implementation of the intervention and an associated education campaign, UT Southwestern’s two teaching hospitals reduced thrombophilia testing for inpatients by more than 90 percent.
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