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ASH Recognizes 2023 Choosing Wisely Champions

ASH Choosing Wisely Champions honorees are tackling over-testing, minimizing waste in health care systems

(WASHINGTON, Oct. 2, 2023) – The American Society of Hematology (ASH) recognizes Luluh Bin Dayil, MSN at King Abdulaziz Medical City in Saudi Arabia; Alessandra Ferrajoli, MD at the University of Texas MD Anderson Cancer Center in Houston, Texas; and Vilmarie Rodriguez, MD, MS at Nationwide Children’s Hospital in Columbus, Ohio as Choosing Wisely® Champions working to tackle the overuse of hematology tests and treatments.

Choosing Wisely is an initiative started by the ABIM Foundation that seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments, and procedures. As part of this initiative, ASH 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 ASH Choosing Wisely program recognizes clinicians who have implemented successful projects to reduce overuse in their practice, institution, or hospital system.

The 2023 ASH Choosing Wisely Champions will speak during a Special-Interest Session taking place at the 65th ASH Annual Meeting and Exposition in San Diego, California December 9-12, 2023. During this session, the Society will recognize the champions’ efforts and offer attendees the opportunity to ask questions and learn about strategies for implementing similar projects into their own practices.

The 2023 ASH Choosing Wisely Champions are:

Luluh Bin Dayil, MSN (King Abdulaziz Medical City in Saudi Arabia)
Five-Year Outcomes of an Outpatient Chemotherapy Model

The shift toward outpatient delivery of intensive chemotherapy may improve quality-of-life for patients and reduce resource use. Bin Dayil and her multidisciplinary team studied the implementation of intensive outpatient chemotherapy among patients with hematological neoplasms at King Abdulaziz Medical City.

The team evaluated patient records from 2016-2017 to facilitate the outpatient delivery of chemotherapy, which included the development of clinical pathways for chemotherapy protocols, facilitating access to emergency care services, and the creation of educational materials for patients and health care staff. The implementation of this intervention has improved patient safety outcomes, enhanced patient satisfaction, and saved an estimated $2.88 million.

Alessandra Ferrajoli, MD (University of Texas MD Anderson Cancer Center) 
Treatment Algorithm for Abnormal Uterine Bleeding 

Abnormal uterine bleeding in patients with hematological malignancies leads to frequent episodes of bleeding and an increased need for blood transfusions. Dr. Ferrajoli and colleagues aimed to standardize and improve the prevention and treatment of uterine bleeding among patients with hematologic malignancies.  

The team created an algorithm to guide clinicians in the administration of leuprolide, a drug used to treat endometriosis and fibroids, with or without oral contraceptives, based on a review of available literature and the contribution of a multidisciplinary working group. The implementation of the algorithm led to an increase in the percentage of patients with hematological malignancies who received leuprolide to 30.3% from 19.2%. For patients who underwent allogeneic stem cell transplantation, the administration of leuprolide reduced the need for red blood cell and platelet transfusions when compared to patients who were not treated with leuprolide.

Vilmarie Rodriguez, MD, MS (Nationwide Children’s Hospital, The Ohio State University) 
Reduced Blood Transfusions for Pediatric Iron Deficiency Anemia 

Pediatric patients with moderate to severe iron deficiency anemia (IDA) often receive blood transfusions, despite recommendations not to transfuse red blood cells for IDA when there is no evidence or risk of cardiorespiratory instability or active bleeding. Blood transfusions improve hemoglobin levels, but do not correct iron deficiency and can lead to patient risks, including transfusion reactions, bloodborne infections, volume overload, and risk for red blood cell alloimmunizations. Blood transfusions come at an average cost of $1,000 at Nationwide Children’s Hospital (NCH).  

Dr. Rodriguez led a multidisciplinary team to analyze the indicators for transfusions at NCH and develop interventions to reduce blood transfusions in IDA and increase the appropriateness of red blood cell transfusions. Since implementation, blood transfusions decreased to a mean of 34% from 74% and the appropriateness of blood transfusions increased to 95% from 82%.

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’s flagship journal, Blood (www.bloodjournal.org) is the most cited peer-reviewed publication in the field, and Blood Advances (www.bloodadvances.org) is an open-access, online journal that publishes more peer-reviewed hematology research than any other academic journal worldwide.

Melissa McGue, American Society of Hematology
[email protected]; 202-552-4927