Enhancing the Understanding and Utilization of Hypercoagulable Workup: A Quality Improvement Initiative

Area of Science:

• Clinical Pathology
• Healthcare Quality Improvement
• Medical Diagnostics

Background:

• Hypercoagulable testing is often overutilized in hospitalized patients, especially during acute thrombosis or anticoagulation.
• Test results can be unreliable and unlikely to impact management in these settings.
• This overutilization represents a significant quality gap in healthcare delivery.

Purpose of the Study:

• To enhance provider understanding of hypercoagulable testing guidelines.
• To reduce the incidence of inappropriate hypercoagulable test orders.
• To improve the overall quality of diagnostic test utilization in inpatient settings.

Main Methods:

• A quality improvement initiative was implemented using electronic medical record (EMR) modifications and targeted provider education.
• Retrospective chart reviews were conducted pre- and post-intervention to assess the appropriateness of thrombosis panel orders.
• Appropriateness was evaluated against established clinical guidelines for hypercoagulable testing.

Main Results:

• Pre-intervention, 90.5% of 262 thrombosis panels were inappropriate; post-intervention, appropriate ordering increased to 40.2%.
• Inappropriate ordering of protein C, protein S, and antithrombin III tests decreased significantly.
• A notable reduction in testing without clear indications or confirmed venous thromboembolism was observed.

Conclusions:

• Combining EMR changes with targeted education effectively improves appropriate hypercoagulable test utilization.
• This quality improvement initiative successfully reduced low-value testing and promoted guideline adherence.
• Such interventions support more effective clinical decision-making and optimize resource allocation in healthcare.