The physician-led “Choosing Wisely” campaign of the American Board of Internal Medicine Foundation, which has huge potential to improve health care quality while lowering costs, received another important boost with the American Society of Hematology's list of five hematology tests, treatments, and procedures that are common—and frequently not appropriate.
ASH's “Top 5” list is as follows:
- Limit surveillance computed tomography scans in asymptomatic patients following curative-intent treatment for aggressive lymphoma.
- Don't use inferior vena cava filters routinely 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 a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac, inpatients).
- Do not test for thrombophilia in adult patients with VTE occurring in the setting of major transient risk factors (surgery, trauma or prolonged immobility).
- Do not administer plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists (i.e. outside of the setting of major bleeding, intracranial hemorrhage or anticipated emergent surgery).
A manuscript detailing the recommendations is now online ahead of print in Blood (doi: 10.1182/blood-2013-07-518423).
In publishing its list, ASH joins ASCO, ASTRO, the American College of Surgeons, the Commission on Cancer, and many other medical societies that are encouraging their members to “choose wisely” when they prescribe tests and treatments.
“Hematology is a specialty with many new and increasingly expensive tests and treatments,” the Chair of the ASH Choosing Wisely Task Force, Lisa Hicks, MD, of St. Michael's Hospital and the University of Toronto, said in a news release. “While these new diagnostic and treatment strategies represent important advances, there is also potential to pose significant harm and cost to patients if over- or mis-used.
“The ASH Choosing Wisely list serves as a reminder to hematologists to take a step back and question whether certain routinely used procedures are really necessary, and to gradually change their practices to maximize the value of care.”
The guiding principles of the Choosing Wisely campaign are evidence, cost, frequency, and scope of practice, but ASH chose to add another criterion: the concept of avoiding harm. Thus, the news release notes, tests, procedures or treatments that are likely to increase the risk of harm were prioritized during ASH's selection process.