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Reducing inpatient heritable thrombophilia testing using a clinical decision-making tool.

Tyler W Smith1, David Pi, Monika Hudoba

  • 1Department of Medicine, University of British Columbia, , Vancouver, British Columbia, Canada.

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|October 31, 2013
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Summary

A clinical decision tool significantly reduced heritable thrombophilia (HT) testing in hospitalized patients by 79.4%. This intervention decreased testing across multiple specialties, warranting further patient outcome studies.

Keywords:
CLOTTINGLABORATORY MANAGEMENTLABORATORY TESTSTHROMBOPHILIATHROMBOSIS

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Area of Science:

  • Clinical Medicine
  • Medical Diagnostics
  • Health Services Research

Background:

  • Heritable thrombophilia (HT) testing is utilized in hospitalized patients.
  • The appropriateness and volume of HT testing in inpatient settings require evaluation.
  • Clinical decision-making tools can influence physician ordering behavior.

Purpose of the Study:

  • To assess the impact of a clinical decision-making tool on heritable thrombophilia (HT) testing volumes.
  • To evaluate the tool's effectiveness in a tertiary care hospital setting for inpatients.

Main Methods:

  • Retrospective cohort study conducted over six years (2007-2012) at one intervention and two control sites.
  • Implementation of a pre-preprinted order (PPO) form for HT testing, requiring physician completion.
  • The PPO outlined testing limitations; failure to complete it within 24 hours led to test cancellation.

Main Results:

  • A 79.4% reduction in factor V Leiden (FVL) testing was observed at the intervention site post-PPO implementation.
  • This reduction was significantly greater than in control hospitals (33.7% and 43.6% decreases).
  • Significant decreases were also noted for antithrombin (57.4%), protein C (61.9%), and protein S (62.2%) activity assays.

Conclusions:

  • A clinical decision-making tool effectively reduced inpatient heritable thrombophilia (HT) testing across specialties.
  • The intervention demonstrated a substantial impact on laboratory test utilization.
  • Further studies are recommended to evaluate the impact of reduced HT testing on patient outcomes.