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. 2022 Oct 6;36(1):24-29.
doi: 10.1080/08998280.2022.2127578. eCollection 2023.

Reducing inappropriate inpatient thrombophilia testing through an electronic health record intervention

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Free PMC article

Reducing inappropriate inpatient thrombophilia testing through an electronic health record intervention

Charis Durham et al. Proc (Bayl Univ Med Cent). .
Free PMC article

Abstract

Current literature does not support routine testing for hereditary and acquired thrombophilia disorders in the inpatient setting. Testing in the acute setting rarely changes patient management or could lead to patient mismanagement. Despite prior educational interventions, continued overuse of inpatient testing warrants further quality improvement measures. A hard-stop best practice advisory pop-up was implemented in the electronic medical record in a multicenter academic hospital system to provide clinicians guidance on the appropriate use of thrombophilia testing at the point of care. Pre- and postintervention retrospective data were collected to assess clinical features before and after implementation. Before the intervention, 271 patients underwent inpatient hypercoagulability testing; after the intervention, 238 patients underwent inpatient hypercoagulability testing. The total number of labs ordered per patient decreased from 1185 to 910, a 13% reduction (P = 0.003). Overall, there was a savings of $23,597 in total direct cost and $123,153 in total charges when comparing the 6-month timeframes before and after the intervention (P < 0.01). Although this study found only mild reductions in thrombophilia testing, it presents a new means of providing point-of-care intervention and education for hypercoagulability testing in the inpatient setting.

Keywords: Benign hematology; hypercoagulability testing; quality control; thrombophilia testing.

Figures

Figure 1.
Figure 1.
Best practice advisory pop-up generated when a hypercoagulable workup was ordered on the inpatient electronic orders (demonstration with a false patient name). The hard stop could be bypassed if the ordering provider indicated that the order would either impact inpatient management or was requested by the hematology consult service.
Figure 2.
Figure 2.
Changes in (a) direct cost and (b) charges per patient (P < 0.0001).

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