ASH to Recognize Choosing Wisely Champions at 62nd Annual Meeting
(WASHINGTON, Dec. 3, 2020) — The American Society of Hematology (ASH) will recognize three Choosing Wisely® Champions, practitioners working to tackle overuse of hematology tests and treatments, at the upcoming all-virtual 62nd ASH Annual Meeting and Exposition, December 5-8, 2020.
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 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 on Sunday, December 6, at the all-virtual 2020 ASH Annual Meeting, where the Society will recognize their efforts and provide attendees with an opportunity to learn about projects that might be translated to their own practices.
“Each year the American Society of Hematology spotlights Choosing Wisely Champions who lead by example and show that making systemic improvements to enhance the quality of patient care can happen everywhere,” said Anita Rajasekhar, MD, of the University of Florida and chair of the ASH Subcommittee on Stewardship and Systems-Based Hematology, which selected the winners. “This year’s Choosing Wisely Champions will present how they identified ineffective or non-evidence-based practices at their institutions and describe the changes they implemented to yield sweeping institution-wide improvements for their patients.”
The 2020 ASH Choosing Wisely Champions are:
Sriman Swarup, MD, Texas Tech University Health Sciences Center, Lubbock, Texas
A restructured approach to the diagnosis of heparin-induced thrombocytopenia (HIT)
Dr. Swarup and colleagues examined data over one year to understand how often clinicians at their large tertiary academic hospital ordered the 4T screening pretest for heparin-induced thrombocytopenia (a dangerous immune response to treatment, also known as HIT) before ordering the HIT screening antibody test They learned that 4T scoring was incorporated into each patient’s electronic medical record and was made a compulsory part of the HIT workup, with post-intervention prevalence noted. It was determined that the antibody screening test done at the hospital was outdated (Platelet Immuno-Filtration assay), and so it was replaced with a new HIT screening antibody test (Latex Immunoassay). This intervention led to improved use of the 4T scoring system, which translated to the reduction of inpatient stay, alternative anticoagulation used, and health care expenditure in the target population six months post-intervention.
Hind Salama, MD, King Abdulaziz Medical City, Riyadh, Saudi Arabia, Oncology Department
Reducing futile acute care services for terminally ill cancer patients: The Dignity Project
The Dignity Project is a quality improvement project held at King Abdulaziz Medical City, Department of Oncology, with an aim to reduce the of unnecessary usage of acute care services (ACS) for cancer patients treated with a palliative intent approach. The project was carried out in 3 phases, a pre intervention phase to assess the magnitude of the problem, an intervention model to improve the practice and a post intervention phase to assess the outcome of the intervention model. The main components of the intervention model were : Multidisciplinary meetings to decide and document the goal of treatment for each cancer patient, regular Education of the staff, patients and their families; implementation of mandatory documentation of the goals of care in the electronic health care record system, and early referral to palliative care. Following the intervention period, timely documentation of goal of care has improved from 59%to 83% and ICU admission had decreased from 26% to 12% in the pre and post-intervention phases, respectively. This resulted in annual cost saving of 601,200 USD.
Arielle L Langer, MD MPH, Brigham and Women’s Hospital, Boston, MA
Reducing unnecessary thrombophilia testing
Patients with venous thromboembolism (VTE) are often subjected to extensive laboratory testing, despite the fact that it usually does not impact management of their condition. Dr. Langer and colleagues were concerned that positive test results could lead to excessive anticoagulation and negative results could lead to withholding of needed anticoagulation. To reduce testing, they developed a consensus testing algorithm, along with an educational campaign. In order to make default practices less likely to deviate from these guidelines, they also implemented order sets changes. Prior to the intervention, Dr. Langer noted a high volume of low-yield thrombophilia testing – on average 801 tests per month – at their institution. After these interventions, there was a 17.1% reduction in overall testing (p = 0.007). The greatest reduction was in the outpatient practices of the hematology/oncology division, which showed a 45.9% reduction (p = 0.007). Due to the high cost of these tests, the reduction in testing resulted in a savings of $31,626.82 per month without compromising patient care.
The American Society of Hematology (ASH) 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 60 years, the Society has led the development of hematology as a discipline by promoting research, patient care, education, training, and advocacy in hematology. ASH publishes Blood (www.bloodjournal.org), the most cited peer-reviewed publication in the field, and Blood Advances (www.bloodadvances.org), an online, peer-reviewed open access journal.
Amanda Szabo, American Society of Hematology