Thrombophilia testing in the inpatient setting: impact of an educational intervention

• Published in: BMC medical informatics and decision making Vol. 19; no. 1; p. 167
• Main Authors: Kwang, Henry, Mou, Eric, Richman, Ilana, Kumar, Andre, Berube, Caroline, Kaimal, Rajani, Ahuja, Neera, Harman, Stephanie, Johnson, Tyler, Shah, Neil, Witteles, Ronald, Harrington, Robert, Shieh, Lisa, Hom, Jason
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20-08-2019; BioMed Central; BMC
• Subjects: Adult; Analysis; Anticoagulants; Care and treatment; Clinical decision making; Complications and side effects; Decision making; Diagnosis; Education; Epidemiology; Female; Health aspects; Health facilities construction; Health informatics; High value care; Hospital patients; Hospitalization; Hospitals, University; Humans; Hypercoagulation; Inpatient; Internal medicine; Internal Medicine - education; Internship and Residency; Intervention; Male; Medical research; Medicine; Mutation; Patient Selection; Patients; Physicians; Pregnancy; Reduction; Risk factors; Teaching; Test procedures; Thromboembolism; Thrombophilia; Thrombophilia - diagnosis; Thrombosis; Thrombophilia; Inpatient; Education; High value care
• ISSN: 1472-6947; 1472-6947
• DOI: 10.1186/s12911-019-0889-6

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.
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.
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.
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.