Advertisement

Journal of General Internal Medicine

, Volume 34, Issue 1, pp 29–30 | Cite as

An Electronic Best Practice Alert Based on Choosing Wisely Guidelines Reduces Thrombophilia Testing in the Outpatient Setting

  • Tomi Jun
  • Henry Kwang
  • Eric Mou
  • Caroline Berube
  • Jason Bentley
  • Lisa Shieh
  • Jason HomEmail author
Concise Research Reports

INTRODUCTION

Thrombophilia testing in the setting of acute venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is often inappropriate. Interpretation of many of the biochemical thrombophilia assays is confounded by anticoagulation or acute thrombus, and thrombophilia testing rarely affects immediate clinical decision-making.1, 2, 3

In an effort to curtail inappropriate thrombophilia testing, the American Society of Hematology (ASH) has issued Choosing Wisely guidelines recommending against thrombophilia testing in patients with VTE in the setting of major transient risk factors (surgery, trauma, and immobility).4 We evaluated the effect of a “Choosing Wisely” best practice alert (BPA) embedded into the electronic medical record (EMR) on thrombophilia testing patterns.

METHODS

This before-and-after study involved patients with a diagnosis of VTE seen at our center between January 1, 2016 and April 30, 2017. The study was approved by the...

KEY WORDS

thrombophilia best practice alert venous thromboembolism 

Notes

Acknowledgements

We gratefully acknowledge Mehran Teymourtash, Melissa Meixsell, and Anibal Perez, RN, for their assistance with data acquisition for this study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    Mou E, Kwang H, Hom J, et al. Magnitude of Potentially Inappropriate Thrombophilia Testing in the Inpatient Hospital Setting. J Hosp Med. 2017;12(9):735–738. doi: https://doi.org/10.12788/jhm.2819 CrossRefPubMedGoogle Scholar
  2. 2.
    Cox N, Johnson SA, Vazquez S, et al. Patterns and Appropriateness of Thrombophilia Testing in an Academic Medical Center. J Hosp Med. 2017;12(9):705–709. doi: https://doi.org/10.12788/jhm.2804 CrossRefPubMedGoogle Scholar
  3. 3.
    Shen Y-M, Tsai J, Taiwo E, et al. Analysis of Thrombophilia Test Ordering Practices at an Academic Center: a Proposal for Appropriate Testing to Reduce Harm and Cost. PloS One. 2016;11(5):e0155326. doi: https://doi.org/10.1371/journal.pone.0155326 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    American Society of Hematology | Choosing Wisely. http://www.choosingwisely.org/societies/american-society-of-hematology/. Accessed January 27, 2017.
  5. 5.
    Smith TW, Pi D, Hudoba M, Lee AYY. Reducing inpatient heritable thrombophilia testing using a clinical decision-making tool. J Clin Pathol. 2014;67(4):345–349. doi: https://doi.org/10.1136/jclinpath-2013-201840 CrossRefPubMedGoogle Scholar
  6. 6.
    Goodnough LT, Shieh L, Hadhazy E, Cheng N, Khari P, Maggio P. Improved blood utilization using real-time clinical decision support. Transfusion (Paris). 2014;54(5):1358–1365. doi: https://doi.org/10.1111/trf.12445 CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Tomi Jun
    • 1
  • Henry Kwang
    • 1
  • Eric Mou
    • 2
  • Caroline Berube
    • 2
  • Jason Bentley
    • 3
  • Lisa Shieh
    • 4
  • Jason Hom
    • 4
    Email author
  1. 1.Department of MedicineStanford University School of MedicineStanfordUSA
  2. 2.Department of Medicine, Division of HematologyStanford University School of MedicineStanfordUSA
  3. 3.Department of Medicine, Quantitative Sciences UnitStanford University School of MedicineStanfordUSA
  4. 4.Department of Medicine, Division of Hospital MedicineStanford University School of MedicineStanfordUSA

Personalised recommendations