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

Background In hospitalized patients, hypercoagulable testing is frequently overutilized, particularly in the context of acute thrombosis or active anticoagulation, when certain results may be unreliable and are unlikely to affect clinical management. This quality improvement (QI) initiative aimed to improve provider understanding and test utilization through electronic medical record (EMR) changes and targeted education. Methodology A retrospective chart review was performed across the St. Luke's University Health Network's campuses to assess thrombosis panel orders from January to April 2024. Following interventions that implemented EMR changes and improved provider education, a post-intervention review was conducted from December 2024 to April 2025. Orders were evaluated for appropriateness based on established guidelines. Results Of the 262 thrombosis panels ordered pre-intervention, 90.5% were deemed inappropriate, with only four identifying a true hypercoagulable condition. Following the intervention, appropriate ordering improved from 9.7% to 40.2%. There was a notable reduction in hypercoagulable workups ordered without a clear indication or confirmed venous thromboembolism, suggesting increased provider awareness of appropriate testing criteria. Inappropriate inpatient ordering of protein C, protein S, and/or antithrombin III activity or antigen levels decreased from 165 cases to 56. Overall, ordering behavior shifted to more guideline-supported indications. Conclusions This QI initiative demonstrated that combining EMR modifications with targeted provider education significantly improves the appropriate use of hypercoagulable testing. Interventions of this kind can reduce low-value testing, promote guideline adherence, and support more effective clinical decision-making.