ASH to Recognize Choosing Wisely Champions at 60th Annual Meeting
Published on: December 02, 2018
December 3, 2018) – The American Society of Hematology (ASH) will recognize
three Choosing Wisely® Champions, practitioners working to tackle overuse of
hematology tests and treatments, today at its 60th annual meeting in San Diego.
Wisely is a program of the ABIM Foundation and Consumer Reports that aims to
prompt conversations between patients and clinicians about the necessity and
potential harm of certain procedures. As a part of this initiative, ASH has
commonly used tests, treatments, and procedures in hematology that
clinicians and patients should question in certain circumstances to avoid
overuse, waste, and harm. Choosing Wisely Champions, an initiative of the ABIM
Foundation, recognizes clinicians who have implemented successful projects to
improve quality at their institutions and advance the goals of the campaign.
ASH Choosing Wisely Champions will speak at a Special-Interest
Session today at the 2018 ASH Annual Meeting, allowing the
Society to recognize their efforts and provide attendees with an opportunity to
learn about projects that might be translated to their own practices.
American Society of Hematology has placed a significant focus on how we, as
hematologists, can improve the quality of care for our patients. One example of
this is the Choosing Wisely Champions Initiative,” said Anita Rajasekhar, MD, of
the University of Florida and co-chair of the ASH Subcommittee on Stewardship
and Systems-Based Hematology, which selected the winners. “This year we are
honoring three exemplary stewardship projects that address overuse of
unnecessary treatments across a broad spectrum of hematology. The speakers will
present the robust process of quality improvement that led to positive change
at their institutions. The goal of this session is to showcase successful
projects and inspire the ASH community to design and implement similar feasible
projects in their own practice.”
ASH Choosing Wisely Champions are:
Binder, MD, Thomas Jefferson University Sidney Kimmel Cancer Center,
was an attending physician at the Montefiore Medical Center in New York, Dr.
Binder and his colleagues developed a process improvement initiative to encourage
the appropriate use of IV vancomycin, an antibiotic, for patients with neutropenic
fever over a 10-month period. Dr. Binder decided to tackle this issue after a
preliminary examination of antibiotic use at his institution revealed
clinicians were overprescribing vancomycin for neutropenic fever based on existing
guidelines. This revelation led to interdisciplinary discussions between the
antibiotic stewardship team, pharmacists, and hematologists.
developed an institutional algorithm to guide prescriptions related to febrile
neutropenia and conducted recurring educational initiatives emphasizing
criteria for appropriate vancomycin initiation based on well-established
guidelines. Post-intervention, appropriate prescribing of vancomycin increased
to 66 percent (from 49 percent pre-intervention), demonstrating that
interdisciplinary development of an algorithm for management of neutropenic
fever can improve the appropriate use of antibiotics.
Lim, MD, Medical University of South Carolina, Charleston, South Carolina
project was developed to address inappropriate testing and care of patients with
suspected heparin-induced thrombocytopenia (HIT). At her institution, she
realized that many patients were being tested for HIT despite having a low
pre-test probability with the 4T score, a risk predictive model with a high
negative predictive value. Further, in patients that did test positive for HIT
through a diagnostic test called platelet-factor four enzyme-linked
immunosorbent assays (PF4 ELISAs), a minority were subsequently being confirmed
with a more specific test, the serotonin-release assay (SRA). In addition,
non-heparin anticoagulants (direct thrombin inhibitors or DTIs) were being
administered needlessly, in many cases, for several days until the SRA assay
results were available. A root cause analysis found that there were
inconsistencies in the way tests were being ordered and management of patients
suspected of having HIT by physicians. There was also no system in place
for the Anticoagulation and Bleeding Management Service team to be
alerted on a daily basis for patients suspected of having HIT.
implementation of a centralized hospital-wide protocol that coordinated testing
and treatment of patients suspected to have HIT led to improved testing and
management of patients. It also led to a substantial reduction in the use of
Vishnu, MD, Mayo Clinic, Jacksonville, Florida
and his team investigated the theory that transfusing one unit of red blood
cells instead of two would be appropriate for hemodynamically stable adult
hospitalized patients undergoing myeloablative chemotherapy (MC) and autologous
hematopoietic stem cell rescue (AHSCR) who have a hemoglobin level of greater
than or equal to seven grams per deciliter.
2017, the team designed and set up an electronic medical record-based
restrictive red blood cell transfusion program as part of a quality initiative
at Mayo Clinic Florida’s hematopoietic stem cell therapy center. Clinicians, hematology trainees, and nurses were educated
about this program with weekly didactic sessions, pamphlets, and verbal
instruction for two months. For each
patient suitable for restrictive red blood cell transfusion, the total number
of red blood cells transfused, the change in hemoglobin pre- and post-
transfusion, time to engraftment, length of hospital stay, and the rate of
sepsis during the first 30 days following MC & AHSCR were recorded.
Data from 2017
were compared to those of a similar group from 2016 and showed a significant
decrease in the total number of red blood cells transfused (28 units in 2017
versus 71 in 2016). Overall, there was no difference in time to engraftment between
those who received red blood cells and those who did not, but the incidence of
sepsis was much higher (70.7 percent versus 51.5 percent) and there was a trend
towards longer hospital stay (16 days versus 14 days) among those who received
red blood cells.
Lim, and Vishnu will present their successful usage strategies during the ASH
Choosing Wisely Campaign: 2018 ASH Choosing Wisely Champions session at the 60th
ASH Annual Meeting on Monday, December 3, 2018, at 12:15 p.m. PST in Room 30D
of the San Diego Convention Center.
Society of Hematology (ASH) (www.hematology.org) is the world's
largest professional society of hematologists dedicated to furthering the
understanding, diagnosis, treatment, and prevention of disorders affecting the
blood. For more than 50 years, the Society has led the development of
hematology as a discipline by promoting research, patient care, education,
training, and advocacy in hematology. The Society publishes Blood (www.bloodjournal.org),
the most cited peer-reviewed publication in the field, as well as the newly
launched, online, open-access journal, Blood Advances (www.bloodadvances.org).
the ABIM Foundation
mission of the ABIM Foundation is to advance medical professionalism to improve
the health care system. We achieve this by collaborating with physicians and
physician leaders, medical trainees, health care delivery systems, payers,
policy makers, consumer organizations and patients to foster a shared
understanding of professionalism and how they can adopt the tenets of
professionalism in practice. To learn more about the ABIM Foundation,
read the ABIM blog blog.abimfoundation.org, or
connect with ABIM on Facebook and Twitter.
announced in December 2011, Choosing Wisely® is part of a
multi-year effort led by the ABIM Foundation to support and engage physicians
in being better stewards of finite health care resources. Participating
specialty societies are working with the ABIM Foundation and Consumer Reports
to share the lists widely with their members and convene discussions about the
physician’s role in helping patients make wise choices. Learn more at www.ChoosingWisely.org.
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Sara Khalaf, American Society of Hematology