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ASH to Recognize Choosing Wisely Champions at 63rd Annual Meeting

(WASHINGTON, Dec. 3, 2021) – The American Society of Hematology (ASH) will recognize three Choosing Wisely® Champions working to tackle overuse of hematology tests and treatments at the 63rd ASH Annual Meeting and Exposition, December 11-14 in Atlanta, Georgia.

Choosing Wisely is an initiative of the ABIM Foundation that seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments, and 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. The Choosing Wisely Champions campaign recognizes clinicians who have implemented successful projects in their practice, institution, or hospital system and provides clinicians, administrators, and other medical professionals with opportunities to learn about projects that might be translated to their own practices. Each year, ASH invites applications from clinicians, researchers, and trainees at all levels and from academic or community settings who have implemented evidence-based quality improvement projects.

The three ASH Choosing Wisely Champions will speak at a Special-Interest Session on Monday, December 13, at the 2021 ASH Annual Meeting, where the Society will recognize their efforts and provide attendees with an opportunity to ask questions and learn about strategies for implementing similar projects into their own practices.

“Each year through Choosing Wisely, ASH recognizes and highlights important implementation efforts that improve the quality of care for patients,” said Ming Y. Lim, MBBCH, MS, of University of Utah Health and chair of the ASH Subcommittee on Stewardship and Systems-Based Hematology, which reviewed highly competitive applications and selected the finalists. “This year’s Choosing Wisely Champions noticed specific gaps in quality care at their institutions, dedicated time and research to develop implementable strategies, and as a result made direct, measurable improvements for their patients.”

The 2021 ASH Choosing Wisely Champions are:

Matthew T. McEvoy, MD, Texas Children’s Hospital, Houston, Texas
A risk-adapted approach to reduce variability and optimize management for pediatric nutritional iron deficiency anemia in the emergency department

Dr. McEvoy and colleagues saw that emergency departments lacked a consistent, systematic approach to managing care among children younger than five years old being admitted for iron deficiency anemia. As a result, children were receiving inappropriate laboratory evaluations, unnecessary transfusions or hospital admissions, and suboptimal administration of oral or intravenous iron. To standardize and improve care for these patients, Dr. McEvoy and colleagues created a novel clinical algorithm accounting for risk based on anemia severity. With input from leading experts in hematology, emergency medicine, transfusion medicine, inpatient nursing, and departmental quality oversight committees, the team formalized and implemented the algorithm into clinical practice. Use of the algorithm by providers led to an increase in several outcome quality measures, including optimal laboratory evaluation (increased from 42.5% to 71.4%), therapy choice (increased from 77.5% to 100%), optimal therapy administration (increased from 50.0% to 83.3%) and disposition guidelines (increased from 84.8% to 100%).

Thomas Bodley, MD, Sunnybrook Health Sciences Center, Toronto, Ontario
Reducing unnecessary and repetitive diagnostic phlebotomy in an intensive care unit: a quality improvement study

In the intensive care unit (ICU), blood testing is an essential component of diagnosis, monitoring, and treatment. However, many ICU blood tests are reflexive and unnecessary, and blood loss from repeated blood tests can cause those in the ICU to need red blood cell transfusions, develop ICU acquired anemia, or need to extend their stay in the hospital. In their study, Dr. Bodley and colleagues aimed to reduce the amount of blood taken from patients each day by 15%, as well as to reduce the number of discrete blood draws per patient per day. They implemented a series of strategies to achieve this aim, including education sessions, workflow changes, implementation of add-on testing, and electronic order set modifications. As a result, the mean blood volume decreased from approximately 41 mL per patient-day to approximately 35 mL per patient day. The number of blood draws per patient per day also decreased, from an average of 3.2 draws to an average of 2.8. The work of Dr. Bodley and colleagues demonstrates that improvement interventions can reduce serial blood draws in the ICU.

Srila Gopal, MD, University of California, San Diego
Establishing same day infusion treatment protocols for uncomplicated sickle cell vaso-occlusive crises using a telemedicine platform

Individuals living with sickle cell disease (SCD) experience vaso-occlusive crises (VOC), a common painful complication that occurs when sickled cells cluster together and obstruct the flow of blood in the body. An individual with SCD may seek care in the emergency department for a VOC, but early, adequate treatment of pain in an outpatient-based infusion center (IC) setting is key to avoiding hospital visits. During the COVID-19 pandemic-related shutdowns, Dr. Gopal and colleagues recognized that they would need an alternate way to keep these patients getting their necessary care. They created a telemedicine platform to continue IC treatment with a multi-disciplinary team of providers including a nurse case manager, advanced practice provider, doctor, IC scheduler, and IC charge nurse. After implementation of the telemedicine approach, and optimizing their workflow, IC visits increased (579 visits as compared to 546 visits), and emergency department visits decreased (132 visits as compared to 162 visits). The work of Dr. Gopal and colleagues represents an effective strategy that smaller sickle cell programs, including those with limited resources, can implement and use.

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 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.

Leah Enser, American Society of Hematology
[email protected]; 202-552-4927