Choosing Wisely: Not Just for Patients, But Colleagues, Too
At the recent 2014 ASH Annual Meeting, the second “Top 5” list as part of the ABIM Foundation's Choosing Wisely® campaign was released. As part of a nationwide effort to control unnecessary practices and procedures in medicine, ASH contributed five additional evidence-based patient-centered items for the most recent list:
- Duration of anticoagulation following a first deep-vein thrombosis (DVT) associated with a major transient risk factor (three months)
- Routine transfusion of sickle cell patients (not recommended)
- Testing for heparin-induced thrombocytopenia in low-probability settings (also not advised)
- Not performing baseline or routine computed tomography scans in patients with asymptomatic, early-stage chronic lymphocytic leukemia
- Transfusing platelets in patients with immune thrombocytopenic purpura in the absence of bleeding or a very low platelet count (not necessary)
Hematology fellows can envision many opportunities to educate patients, fellow trainees, and colleagues regarding an evidence-based approach to patient management with the goal of reducing unnecessary treatments and testing.
Our role as consultants is essential to guiding our patients and colleagues in understanding diagnostic and therapeutic choices. Some examples from the previous iteration of the ASH Choosing Wisely list include avoiding transfusion of more than the minimum number of units of blood necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, noncardiac inpatients). Another list item addresses a common consultation issue of whether to test for thrombophilia in the setting of DVT provoked by a major transient risk factor (the answer: no). And if the patient does have a DVT, inferior vena cava filters should not be routinely inserted.
This is just one of many opportunities to ensure safety in health care. Health care innovations based on the Choosing Wisely initiative include pop-up windows in electronic medical records to ask whether a test or therapeutic should be ordered. However, simply giving a brief talk during noon conference/morning report, or incorporating the Choosing Wisely guidelines in our consult notes, can also help spread safe and value-based decision processes in medicine. To learn more about the ASH Choosing Wisely campaign, visit the ChoosingWisely page.