Reducing inpatient heritable thrombophilia testing using a clinical decision-making tool. Issue 4 (29th October 2013)

• Record Type: Journal Article
• Authors: Smith, Tyler W; Pi, David; Hudoba, Monika; Lee, Agnes Y Y
• Is Part Of: Journal of clinical pathology. Volume 67:Issue 4(2014)
• Page Start: 345
• Page End: 349
• Publication Date: 2013-10-29
• Subjects: THROMBOPHILIA -- THROMBOSIS -- LABORATORY TESTS -- CLOTTING -- LABORATORY MANAGEMENT; Pathology -- Periodicals; Pathology, Molecular -- Periodicals; 616.0705
• DOI: 10.1136/jclinpath-2013-201840
• Languages: English
• ISSNs: 0021-9746

Abstract

Abstract : Aims: To evaluate the impact of a clinical decision-making tool, designed to educate physicians regarding heritable thrombophilia (HT) testing, on the volume of testing in hospitalised patients in the tertiary care setting. Methods: We performed a retrospective cohort study over a 6-year period (2007–2012) at a single tertiary care centre intervention site and two regional control sites. In January 2010, the intervention site instituted a policy change whereby physicians ordering HT testing on inpatients needed to complete a pre-preprinted order (PPO) form that outlined the limitations of HT testing in the hospitalised setting. Failure to complete the PPO within 24 h resulted in test cancellation. Our main outcome measure was the volume of HT testing performed at the three study sites. Results: Introduction of the PPO resulted in a 79.4% (95% CI 71.2% to 87.6%) reduction in factor V Leiden (FVL) testing at the intervention site. This decrease was significantly greater compared with those in the two control teaching hospitals over the same time periods (33.7% and 43.6%; both p<0.001). Reductions in FVL testing postintervention were observed among all ordering specialists. Similar postintervention reductions in testing volumes were observed for antithrombin (57.4%), protein C (61.9%) and protein S (62.2%) activity assays. Conclusions: In a large tertiary care hospital, the introduction of a clinical decision-making tool significantly reduced HT testing in inpatients across clinical specialties. The impact on patient outcome should be assessed in further studies.