Champions Project Archive
2022 Champions
W. Andres Vasconez Samaniego, MD
Affiliation at Time of Research Study: Pediatric Residency Training program at the University of Miami/Holtz Children’s Hospital at Jackson Memorial Medical Center, Miami, FL
Current Affiliation: Combined Pediatric Hematology and Oncology Fellowship at the Johns Hopkins University/National Cancer Institute, Pediatric Oncology Branch, National Institutes of Health, Baltimore and Bethesda, MD
Reducing time to analgesia in the care of Sickle Cell Disease vaso-occlusive events
Dr. Vasconez Samaniego and colleagues investigated the average time to first analgesic dose delivery in the Pediatric ED to patients with Sickle Cell Disease SCD vaso-occlusive pain events and found it was higher than the national recommendation. The most current guidelines from the National Heart Lung Blood Institute and the American Society of Hematology were utilized to streamline pain management in the Pediatric ED at the University of Miami/Holtz Children’s Hospital at Jackson Memorial Medical Center. Following current evidence-based medicine, a multi-disciplinary team assisted health care providers in delivering optimal care to patients with SCD vaso-occlusive episodes.
Time-to-first-analgesic-dose was reduced by 47% with a sustained improvement in Length of Stay through several PDSA cycle interventions that included the creation of a clinical pathway for SCD vaso-occlusive pain events in the Pediatric ED and its integration into the house staff workflow.
Jordan Schaefer, MD, FACP
University of Michigan, Ann Arbor, Michigan
Reducing Excess Aspirin Use Among Patients on Chronic Anticoagulation for Venous Thromboembolic Disease
The 2020 American Society of Hematology (ASH) Guidelines for the Management of Venous Thromboembolism suggest “for patients taking aspirin for primary prevention of [cardiovascular disease] or for stable coronary artery disease, The ASH guideline panel provides a conditional recommendation in favor of suspending aspirin while taking anticoagulant therapy…”. Dr. Schaefer and his colleagues in the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) participated in a quality improvement project starting between October of 2017 and June of 2018 at six diverse clinical sites. They were able to implement this ASH Guideline Recommendation to reduce excess aspirin use among patients anticoagulated for VTE and sustain this effort over several years. Having followed thousands of warfarin anticoagulated patients with VTE, they have shown an over 40% reduction in excess aspirin use. Across MAQI2, reduced aspirin use was associated with improved clinical outcomes without an observed increase in thrombotic outcomes.
Jori E. May, MD
University of Alabama at Birmingham
Improving the Diagnosis and Management of Heparin Induced Thrombocytopenia (HIT) with Automatic Electronic Consultation
Dr. May and her colleagues observed frequent deviation from guideline-supported care in patients with suspicion for and with confirmed heparin-induced thrombocytopenia (HIT). In response, they developed an electronic consultation (e-consultation) system (the “HIT E-consult Service”), in which a hematologist was automatically consulted on all patients with a positive screening immunoassay for HIT. E-consultation was performed via review of the patient medical record, without patient contact, and recommendations were communicated to the consulting team via documentation with telephone conversation as needed.
The HIT E-consult Service consistently recommended against the use of non-heparin anticoagulation in patients with low concern for HIT, resulting in a significant decline in hospital-wide use of bivalirudin, the preferred direct thrombin inhibitor at the institution. The HIT E-consult Service also increased the use of oral factor Xa inhibitors and fondaparinux in appropriate patients. The median length of stay for patients with confirmed HIT decreased with e-consultation from 39 days to 17 days. Additional observed benefits include improve interpretation of complex HIT testing results and increased post-discharge follow-up with hematology for continued face-to-face care.
The efforts of Dr. May and colleagues demonstrate that automatic e-consultation for patients with suspicion for and/or confirmed HIT can improve adherence to guidelines and improve care outcomes.