Innovation, initiative, and insight take center stage at this year’s ASH Choosing Wisely Campaign: 2023 ASH Choosing Wisely Champions Special-Interest Session (Monday, 12:15 p.m. to 1:15 p.m., Convention Center, Room 7). Every year, ASH celebrates three health care pioneers as champions who embody the principles of judicious, informed, efficient, and patient-centered medicine. In this session, the champions will guide us through their journeys from conception to completion as they present innovative strategies that they have designed and integrated in their health care systems to target an area of overuse in medicine. This year’s projects are diverse in terms of their target populations and the areas addressed, but all share a common motivation and theme: improving patient well-being.
Thoughtful Transfusions: Vilmarie Rodriguez, MD, will present on the “Reducing Blood Transfusions in Iron Deficiency Anemia-ReBIDA QI” initiative, which she led at the Nationwide Children’s Hospital (NCH) in Ohio, to address unnecessary blood transfusions in pediatric patients with iron deficiency anemia. The interventions included provider and patient education, practice guidelines to standardize management, and integration of order sets in the electronic medical record system. Since its implementation in March 2022, the intervention has achieved its goals by leading to a decrease in the rate and an increase in the appropriateness of blood transfusions. According to Dr. Rodriguez, “The collaboration of all team members and stakeholders and the desire to improve patients’ outcomes led to the success of this project,” adding that “a similar strategy can be adopted in other health care settings, perhaps with modifications based on their institution resources.” Blood products are an invaluable resource and in some clinical scenarios, there may be equipoise in deciding whether to transfuse. Such initiatives promote judicious utilization of blood products to not only minimize health care costs and encourage better stewardship of these critical resources, but most importantly to reduce the not-insignificant transfusion-associated risks for patients.
Stop the Bleed: Alessandra Ferrajoli, MD, pioneered an initiative to standardize the management of abnormal uterine bleeding in premenopausal women receiving chemotherapy for hematologic malignancies. Dr. Ferrajoli and her team created and disseminated an algorithm to guide clinicians on the use of leuprolide either alone or in combination with oral contraceptive pills. The project led to an increase in the use of leuprolide and a substantial decrease in transfusion requirement among patients who had undergone allogeneic stem cell transplants. For premenopausal women who are already struggling with the side effects of intensive chemotherapy, this initiative aids in alleviating the added stress and symptom burden associated with abnormal uterine bleeding and offers hope for fertility preservation. Dr. Ferrajoli attributes the success of this project to the presence of “an unmet clinical need and the ability to assemble a multidisciplinary team.” The algorithm is publicly available through the MD Anderson website page, allowing for adaptation into any health care system.
“Moving Out!(patient)”: Finally, Ayman Alhejazi, MD, will guide us through his journey of transforming the practice of intensive chemotherapy administration from an inpatient to an outpatient experience. For patients with hematologic malignancies, such an initiative means less time in hospital beds, the ability to maintain daily routines, increased autonomy, and improved emotional well-being. For Dr. Alhejazi and his colleagues at King Abdulaziz Medical City in Saudi Arabia, this meant establishing an intensive outpatient chemotherapy clinic, reallocating resources, reconfiguring chemotherapy protocols, and developing educational materials for patients and staff. According to the team, the biggest challenge was ensuring timely access to specialized care services for patients who developed complications. This hurdle was overcome by creating designated emergency beds to ensure immediate access to care. Just five years after its implementation, this project has resulted in a cost savings of more than 2 million dollars and has increased patient satisfaction by improving quality of life.
These stories are marked by exceptional achievements but also very tangible challenges, serving as an inspiration for health care providers to practice mindful medicine. Ming Y. Lim, MBBChir, who serves as the chair for this year’s session, remarked, “These diverse projects highlight the fact that overutilization is seen in all areas of hematology, and it is inspiring to see our colleagues dedicate their time and effort to tackling different types of overutilization to improve patient/family satisfaction, safety, and quality of care.” Dr. Lim added: “Although no two health care systems are alike, I hope that the solutions offered will be helpful to attendees when translating these projects to their own practices locally.”
As we listen to these presentations, we are reminded that the art of medicine is not only about what we can do, but what we should do. It is about placing the patient at the heart of every decision and choosing wisely.
Drs. Abdallah and Cook indicated no relevant conflicts of interest.
