Hematologists should not use 5 tests and procedures routinely, according to Choosing Wisely recommendations presented at the 2013 American Society of Hematology (ASH) annual meeting.
In 2009, the Institute of Medicine estimated that $210 billion was wasted on unnecessary healthcare services in the United States across all specialties. “If we could redirect even a fraction of this to real people with real unmet healthcare needs, think of the good that we can do,” said ASH’s Choosing Wisely Task Force Chair Lisa Hicks, MD, of St. Michael’s Hospital and the University of Toronto, Canada.
Following are the 5 tests and procedures that were selected by the Task Force:
- Computed tomography scans. Limit their use in asymptomatic patients following curative-intent treatment for aggressive lymphoma. They do not change outcomes.
- Inferior vena cava filters should not be routinely used in patients with acute venous thromboembolism (VTE).
- Do not transfuse more than the minimum number of red blood cell units necessary to relieve symptoms of anemia or to return a patient to safe hemoglobin range (7 to 8 g/dL in stable noncardiac inpatients).
- Do not test for thrombophilia in adults with VTE occurring in the setting of major transient risk factors such as surgery, trauma, or prolonged immobility.
- Do not administer plasma or prothrombin complex concentrates for nonemergent reversal of vitamin K antagonists (ie, outside the setting of major bleeding, intracranial hemorrhage, or anticipated emergent surgery).
The evidence for these recommendations was analyzed and reviewed over a year-long process by the ASH Task Force with input from the ASH membership.
The list includes only recommendations with strong evidence, and the main guiding principle of the process of making recommendations was to “do no harm.” Other guiding principles were level of evidence, cost, frequency, and scope of practice.
Hicks acknowledged that these 5 recommendations are probably only the tip of the iceberg, but said they represent an important first step in providing top quality care and optimizing outcomes for patients and the healthcare system.
Choosing Wisely is a quality care initiative developed by the American Board of Internal Medicine in collaboration with leading medical societies. It is expected to include more than 250 unnecessary tests and procedures from 30 medical specialty societies.
An article was published online in Blood to coincide with the presentation of the Choosing Wisely list at the ASH meeting. The list can be viewed at www.hematology.org/choosingwisely.
Reference
Hicks LK. ASH Choosing Wisely® list. Presented at: 2013 American Society of Hematology Annual Meeting; December 9, 2013; New Orleans, LA.