Inherited thrombophilia testing in a large tertiary hospital in New Zealand: implementation of a Choosing Wisely protocol to reduce unnecessary testing and costs.

AIM

To evaluate the practice of inherited thrombophilia testing at Waikato Hospital Laboratory, benchmarked against the British Society of Haematology (BSH) guidelines with the plan to reduce unnecessary testing.

METHODS

We retrospectively reviewed data on all inherited thrombophilia tests performed in the Waikato Hospital Laboratory during August 2015. We then established a local Choosing Wisely guideline for testing. A clinical and laboratory programme was developed to facilitate the implementation of this guideline. Ordering practices were re-evaluated six months after the implementation of the Choosing Wisely programme.

RESULTS

Of the 94 requests received in August 2015, only one complied with BSH guidelines. Most abnormal results did not change the clinical management of patients. In the first six months following the implementation of our intervention, there was a significant reduction of tests performed with an estimated savings of $118,000.

CONCLUSIONS

The majority of inherited thrombophilia tests performed in our laboratory did not comply with BSH guidelines. A multimodal inherited thrombophilia Choosing Wisely programme was successful in reducing unnecessary testing. A laboratory protocol that required screening of every inherited thrombophilia request by a haematologist was necessary for the success of this programme.