New Orleans, LA—Five frequently used medical interventions should not be used routinely, according to the American Society of Hematology (ASH) Choosing Wisely campaign. If hematologists follow the 5 recommendations, the savings to the healthcare system would be significant. These tests were selected not only because they are medically inappropriate and drive up cost without benefiting patients, but also because of their potential for harm.
In 2009, inappropriate tests and procedures racked up an estimated $750 billion in the United States. The judicious use of tests, procedures, and imaging could represent tremendous cost-savings.
The following are the evidence-based recommendations for hematologists:
- Computed tomography scans should be limited in asymptomatic patients after curative-intent treatment for aggressive lymphoma
- 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 the symptoms of anemia or to return a patient to a safe hemoglobin range (7-8 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 the nonemergent reversal of vitamin K antagonists (ie, outside the setting of major bleeding, intracranial hemorrhage, or anticipated emergent surgery).
Choosing Wisely is a national initiative led by the American Board of Internal Medicine Foundation. ASH’s contribution to the initiative was developed by an expert task force over a year-long process of rigorous data review and input from the ASH membership. The 5 recommendations were selected based on their potential for harm and on a strong evidence base.
“The value of these evidence-based recommendations is to fortify the clinician in making decisions. We have provided evidence-based, scientific-based reasons to avoid certain practices,” stated task force member Joseph Connors, MD, Clinical Professor of Medical Oncology, University of British Columbia, Vancouver, Canada. “Probably the main reason that clinicians order too many tests [and procedures] is the human impulse to do something for patients rather than to do nothing.”
The recommendations were published online in Blood (Hicks LK, et al. Blood. 2013;122:3879-3883) to coincide with the unveiling of the ASH Choosing Wisely campaign.