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ASH to Recognize Choosing Wisely Champions at 60th Annual Meeting

(WASHINGTON, 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.

Choosing 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 identified 15 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.

The three 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.

“The 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.”

The 2018 ASH Choosing Wisely Champions are:

Adam F. Binder, MD, Thomas Jefferson University Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania 

While he 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.

The team 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.

Ming Lim, MD, Medical University of South Carolina, Charleston, South Carolina

Dr. Lim’s 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.

The 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 DTIs (78%).

Prakash Vishnu, MD, Mayo Clinic, Jacksonville, Florida

Dr. Vishnu 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.

In early 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.

Drs. Binder, 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.

About ASH:

The American 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).

About the ABIM Foundation

The 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, visit www.abimfoundation.org, read the ABIM blog blog.abimfoundation.org, or connect with ABIM on Facebook and Twitter.

About Choosing Wisely®

First 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.

Sara Khalaf, American Society of Hematology 
[email protected]; 202-552-4925