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ASCP 2019 Choosing Wisely Champions Recognized for Reducing Unnecessary Testing

Publication Date: Sep 20, 2019

ASCP is recognizing several healthcare leaders for their commitment to the ABIM Foundation's Choosing Wisely campaign. The Choosing Wisely Champions program, launched by the ABIM Foundation in 2016, was created to recognize clinicians who are leading efforts to reduce overuse and waste in medicine. The program acknowledges the work of those who are dedicated to providing appropriate care and encourages others to follow their lead.

“Identifying Champions and sharing their successes allows all of us to learn from their efforts to improve healthcare delivery,” said Lee H. Hilborne, MD, MPH, DLM(ASCP)^CM, FASCP, chair of the ASCP Effective Test Utilization Steering Committee.

The Choosing Wisely Champions were chosen for advancing appropriate test utilization in their health systems and demonstrating leadership of a local Choosing Wisely effort. Below are the honorees and a synopsis of their achievements.

Gary W. Procop, MD, MS, MASCP*
Cleveland Clinic

A practicing pathologist, Dr. Procop is nationally recognized in the area of test utilization and was one of the initiators of the Choosing Wisely campaign. He is the founder and current co-chair of the Laboratory Stewardship Committee of the Cleveland Clinic healthcare system and pioneered test utilization analysis by introducing effective methods to control unnecessary testing. The electronic measures to apply algorithms which he and his team developed are widely used in Cleveland Clinic hospital system. The importance of these changes is illustrated by the implementation of a system to continuously analyze the ordering of tests and their effectiveness. In collaboration with other pathologists and specialists in internal medicine, Dr. Procop initiated evidence-based analysis of utilization patterns and contributed to the identification of circumstances in which tests are ordered in an inappropriate manner.

Inova Laboratory Test Utilization Best Practice Team
Team Leader: Myong Ho (Lucy) Nam, MD*
Team Members: Anh Dang, Marina Douglas, Sonali Pakala, Bala Subramanian, Hassan Nayer, Arlane Nelson, Karen McHale, Valley Health, Michelle Mason, Maiordys Moreira, Lorraine Stoudt, Susan Alfaro, Ann McClellan, Becky Shade, Martha Andrews.

Inova Health System Laboratories has successfully implemented several single test utilization control measures. Its staff worked with their IT department to create simple, rule-based order options during the past five years. They achieved this through changes that include changing the CBC automated differential (CBC A Diff) to CBC Diff to place CBCDiff in front of CBCMDiff to reduce manual differential testing, changing the default screen for QAM lab (x3) to QAM lab (x1), changing the BNP order guideline to a one time on admission and optional one-time discharge order, and removing the CK-MB reflex order. With these simple changes, many unnecessary tests were reduced. From there, Inova Health System Laboratories and its IT staff took on an ambitious project to create “Interval Test Allowance Rules” with the help of the System Quality Department and several physicians. The purpose was to control duplicate testing and unnecessary repeat testing based on clinically accepted Interval Rules created by the Laboratory Test Utilization Best Practice Team.

Red Blood Cell Utilization Project Team, UCLA Health
Team Leader: Alyssa Ziman, MD*
Team Members: Kevin Baldwin, Ashley Busuttil, Robin Clarke, Meg Furukawa, Andrew Hackbarth, Jeffrey Mayne, Dawn Ward.

UCLA Health improved red blood cell utilization, following the Choosing Wisely recommendation of the AABB aimed at not transfusing “more units of blood than absolutely necessary.” Through a multidisciplinary effort with hospitalists, transfusion medicine, nursing and IT, UCLA Health utilized IT-enabled strategies to increase the number of guideline-indicated red blood cell transfusions and decrease the number of routine two-unit transfusions. A dynamic order set with embedded real-time clinical decision support, based on the patient’s most recent hemoglobin concentration, was created to guide providers to order appropriately. It increased guideline-indicated red blood cell transfusions from 27 percent to nearly 68 percent (average of 55 percent over the past year) and decreased the number of routine two-unit transfusions without intervening hemoglobin assessment from 43 percent to approximately 27 percent (average of 23 percent over the past year).

Throughout this project, pathologists and hospitalists have been educating attending physicians, house staff, and nurses about the Choosing Wisely campaign as it relates to blood transfusion. These educational efforts not only increased awareness of the importance of transfusing wisely, but also increased the appropriateness of transfusions prior to IT intervention. The efforts have resulted in a sustained and continued improvement in overall red blood cell ordering practices since implementation.

Charlene Bierl, MD, PhD
Children’s Hospital of Philadelphia

Dr. Bierl is the Medical Director of Central Laboratory and Phlebotomy Services at the Children’s Hospital of Philadelphia. She previously served as the Director of the Clinical Laboratories at Cooper University Hospital, where she was a leader of multidisciplinary efforts reflective of the Choosing Wisely mission. Over the last nine years, her team made significant efforts to optimize utilization, following many of the Choosing Wisely recommendations. The team developed high level metrics to monitor the financial impact of utilization efforts, as well as feedback reports for ordering clinicians. Dr. Bierl engaged physician and non-physician partners throughout the health system, leading to successful implementation efforts that resulted in ordering patterns more reflective of Choosing Wisely. Two of her published studies on effective test utilization examine the impact of weekly feedback on test ordering patterns and cost per case mix index-adjusted hospital day as a measure of effective laboratory utilization efforts in a growing academic medical center. She has recently moved to the Children’s Hospital of Philadelphia, where she plans to continue her efforts on this initiative. She is also serving as the Associate Professor of Pathology and Laboratory Medicine at the Perelman School of Medicine, University of Pennsylvania.

Stephen Sibbitt, MD, MBA, FACP
BSW Memorial Hospital, Temple Region
Baylor Scott & White Health

Dr. Sibbitt has more than 20 years of experience in health care, holding administrative responsibilities in an academic health system with concurrent roles at affiliate hospitals, including a large Top 100 hospital and Level I Trauma center. He has served in significant leadership roles for numerous professional organizations and the Texas A&M Health Science Center, College of Medicine. In partnership with the Regional President, Dr. Sibbitt is leading the initiative to achieve “Medicare Break Even” within the flagship hospital (Baylor Scott & White Medical Center - Temple). He is guiding his multidisciplinary team to reduce unnecessary expenses related to reduction in length of hospital stay, unnecessary lab and radiology utilization, inappropriate utilization of high cost medications, and cost-inefficient variation in provider practice. He has steadfastly supported the laboratory’s use of the guidelines, educated his peers, and led monthly monitoring and communications of data and results.

Rana Nabulsi, PhD, FACHE, MSc, CPHQ, SSGB
Dubai Health Authority

Dr. Nabulsi serves as a consultant in the Head of Quality Assurance Unit in the Pathology and Genetics Department at Dubai Health Authority. She is a Fellow at the American College of Healthcare Executives and the Chair of the ASCP Board of Certification United Arab Emirates Advisory Board. Dr. Nabulsi completed her PhD in quality management and obtained her Master’s degree in molecular genetics from the Faculty of Medicine at Jordan University. She is a Certified Professional in Healthcare Quality and is certified as a Six Sigma Green Belt by the American Society of Quality. Dr. Nabulsi has promoted the Choosing Wisely guidelines in her training, meetings, and utilization committee, and has done speaker sessions for the same. She has implemented Choosing Wisely guidelines in her organization and conducted operational activities such as moving from ESR to CRP and limiting Vitamin D testing to only high-risk categories.

*The individuals who have an asterisk by their name were selected to present their work at the ASCP 2019 Annual Meeting in Phoenix, Arizona, from September 11-13. They were the top three chosen by the ASCP Effective Test Utilization Steering Committee, based on their Choosing Wisely activities.

Learn more about ASCP's involvement in Choosing Wisely at www.ascp.org/choosingwisely.

Other articles in the October 2019 ePolicy News:

ASCP Delegation Meets with FDA on LDT Oversight
Fix PAMA, Don’t Change Laboratory Date of Service Rule, ASCP Urges CMS
Meaningful Participation Sought Under the QPP for Pathologists in 2020
ASCP Opposes E/M Proposal in Medicare Physician Fee Schedule
CDC Coordinates Investigation, Offers Healthcare Provider Resources Regarding Lung Disease Associated with Vaping
ASCP Expands List of Choosing Wisely Recommendations

To read more articles from ePolicy News click here.

For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.