Thrombophilia testing in the inpatient setting: impact of an educational intervention.
Henry Kwang, Eric Mou, Ilana Richman, Andre Kumar, Caroline Berube, Rajani Kaimal, Neera Ahuja, Stephanie Harman, Tyler Johnson, Neil Shah, Ronald Witteles, Robert Harrington, Lisa Shieh, Jason Hom
Author Information
Henry Kwang: Department of Medicine, Stanford University, Stanford, CA, USA.
Eric Mou: Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA.
Ilana Richman: Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
Andre Kumar: Division of Hospital Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, HC007, Stanford, CA, 94305, USA.
Caroline Berube: Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA.
Rajani Kaimal: Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, CA, USA.
Neera Ahuja: Division of Hospital Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, HC007, Stanford, CA, 94305, USA.
Stephanie Harman: Division of Palliative Care, Department of Medicine, Stanford University, Stanford, CA, USA.
Tyler Johnson: Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA.
Neil Shah: Department of Pathology, Stanford University, Stanford, CA, USA.
Ronald Witteles: Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA, USA.
Robert Harrington: Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA, USA.
Lisa Shieh: Division of Hospital Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, HC007, Stanford, CA, 94305, USA. lshieh@stanford.edu.
Jason Hom: Division of Hospital Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, HC007, Stanford, CA, 94305, USA. jasonhom@stanford.edu. ORCID
BACKGROUND: Thrombophilia testing is frequently ordered in the inpatient setting despite its limited impact on clinical decision-making and unreliable results in the setting of acute thrombosis or ongoing anticoagulation. We sought to determine the effect of an educational intervention in reducing inappropriate thrombophilia testing for hospitalized patients. METHODS: During the 2014 academic year, we implemented an educational intervention with a phase implementation design for Internal Medicine interns at Stanford University Hospital. The educational session covering epidemiology, appropriate thrombophilia evaluation and clinical rationale behind these recommendations. Their ordering behavior was compared with a contemporaneous control (non-medicine and private services) and a historical control (interns from prior academic year). From the analyzed data, we determined the proportion of inappropriate thrombophilia testing of each group. Logistic generalized estimating equations were used to estimate odds ratios for inappropriate thrombophilia testing associated with the intervention. RESULTS: Of 2151 orders included, 934 were deemed inappropriate (43.4%). The two intervention groups placed 147 orders. A pooled analysis of ordering practices by intervention groups revealed a trend toward reduction of inappropriate ordering (p = 0.053). By the end of the study, the intervention groups had significantly lower rates of inappropriate testing compared to historical or contemporaneous controls. CONCLUSION: A brief educational intervention was associated with a trend toward reduction in inappropriate thrombophilia testing. These findings suggest that focused education on thrombophilia testing can positively impact inpatient ordering practices.
