Article Text

PDF
Reducing inpatient heritable thrombophilia testing using a clinical decision-making tool
  1. Tyler W Smith1,
  2. David Pi2,
  3. Monika Hudoba2,
  4. Agnes Y Y Lee1
  1. 1Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Corresponding to Dr Agnes Y Y Lee, Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th floor, Vancouver, BC, Canada V5Z 1M9; alee14{at}bccancer.bc.ca

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.

  • THROMBOPHILIA
  • THROMBOSIS
  • LABORATORY TESTS
  • CLOTTING
  • LABORATORY MANAGEMENT

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.