Ruka Myra, Moore Helen, O'Keeffe Denis
Haematology Department and Haematology Laboratory, Waikato Hospital, Hamilton.
Haematology Department and Haematology Laboratory, Waikato Hospital, Hamilton; Haematology, Pathlab Angelsea, Hamilton.
N Z Med J. 2020 Apr 3;133(1512):45-58.
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.
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.
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.
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.
评估怀卡托医院实验室进行遗传性血栓形成倾向检测的情况，以英国血液学学会（BSH）指南为基准，并计划减少不必要的检测。
我们回顾性分析了2015年8月在怀卡托医院实验室进行的所有遗传性血栓形成倾向检测的数据。然后制定了本地的明智选择检测指南。制定了一个临床和实验室项目以促进该指南的实施。在实施明智选择项目六个月后，重新评估了检测申请情况。
2015年8月收到的94份检测申请中，只有一份符合BSH指南。大多数异常结果并未改变患者的临床管理。在我们的干预措施实施后的前六个月，检测数量显著减少，估计节省了11.8万美元。
我们实验室进行的大多数遗传性血栓形成倾向检测不符合BSH指南。一个多模式的遗传性血栓形成倾向明智选择项目成功减少了不必要检测。该项目成功的必要条件是制定一项实验室规程，要求血液科医生对每一项遗传性血栓形成倾向检测申请进行筛查。
