Requirement for a Pathologist's Second Signature Limits Inappropriate Inpatient Thrombophilia Testing

Thromboembolism is a condition that leads to the hospitalization of thousands of patients in the United States annually. Recent guidelines suggest that testing for hereditary, acquired and combined forms of thrombophilia be delayed following hospitalization for a first-time acute thrombotic event. Instead, thrombophilia testing would be performed in an outpatient setting, at least 1 month after discontinuation of anticoagulant therapy or 3 months after the thrombotic event, on the understanding that anticoagulation may affect some testing. Here, we provide our experience in instituting a system-wide policy change to limit thrombophilia testing in the inpatient setting. The policy change implemented led to a 90% reduction in number of tests ordered. We discuss the cost savings realized by limiting testing. These changes cost nothing to implement. Overall, limiting inpatient thrombophilia testing improves compliance with testing guidelines, provides better care for patients, and allows our institution to better utilize resources.