ASH’s commitment to quality improvement in hematology care has remained steadfast, progressive, and essential. Each year, ASH celebrates the groundbreaking work of researchers and practitioners who have made significant strides in improving the quality of care. This year, ASH is merging two sessions — ASH Choosing Wisely Champions and ASH Guideline Implementation Champions — into a dynamic 90-minute event: ASH Quality Improvement Champions (Monday, 2:45 p.m. to 4:15 p.m., CC, Room 7) that promises to spotlight the pioneering efforts of three health care professionals who have transformed care delivery within their practices, hospitals, and systems.
These 2024 ASH Quality Improvement Champions will share their projects aimed at delivering timely yet cost-efficient care to three distinct populations of patients who are at high risk of bleeding and its complications.
While iron deficiency anemia (IDA) due to heavy menstrual bleeding (HMB) is the leading cause of anemia in adolescent patients, it remains an underdiagnosed and undertreated condition, particularly in emergency department settings, with few comprehensive guidelines available. To address this gap, Josie Fernandez Sanchez, MD, of Texas Children’s Hospital and Baylor College of Medicine, spearheaded a multidisciplinary initiative to target the heterogeneity of care that this population receives for IDA. Her team’s efforts led to the creation and implementation of an evidence-based algorithm for diagnosing and treating IDA among adolescents with HMB, allowing for more timely and effective care. This algorithm instructed emergency department (ED) providers to assess patients with HMB for red-flag symptoms, directed which laboratory studies to order and how to interpret them, and then provided blood transfusion, iron supplementation, and/or estrogen therapy recommendations based on severity of symptoms, severity of anemia, and social situation. The algorithm led to a statistically significant difference in appropriate therapy being administered in the ED — from 57% to 92%.
In response to a previous presentation on hemostatic balance in patients with chronic liver disease (CLD) and the recommendation against prophylactic fresh frozen plasma (FFP) and platelet transfusions before paracentesis, Paolo Lopedote, MD, of City of Hope National Medical Center, took the initiative to implement similar practices at his former institution, St. Elizabeth’s Medical Center in Boston. According to Dr. Lopedote, he was an internal medicine resident on call overnight when he was instructed during patient hand-off “to make sure Mr. X with cirrhosis received platelets before his paracentesis in the morning.” Aware of the recently presented research in this population, Dr. Lopedote wanted to translate that research into practice at his institution. Like Dr. Fernandez Sanchez, Dr. Lopedote led a multidisciplinary task force to distribute education flyers throughout key areas of the hospital, administer questionnaires to residents about their knowledge of this subject, and provide didactic sessions for the residents to educate and inform them that low-risk bleeding procedures do not necessitate prophylactic blood products in patients with cirrhosis. This initiative resulted in a 75% reduction in FFP and platelet transfusions prior to paracenteses in one year.
To round out the event, Asinamai Ndai, BPharm, MS, of University of Florida Health, will discuss his development and implementation of a rapid triage system and specialized medication order set for emergency department physicians treating patients with hemophilia. Mr. Ndai and his colleagues identified delays in factor replacement therapy (FRT) for patients with hemophilia in the emergency department, a critical issue that can significantly impact morbidity and mortality in this population. Mr. Ndai and his team were able to reduce the average length of time from presentation to administration of FRT from 5.3 hours to 3.1 hours, due in large part to the rapid triage system that they developed.
“We developed a system where once the medical record number (MRN) of a patient with hemophilia was entered by the intake staff, this triggered a bypass system that allowed these patients to more rapidly be assessed by a provider,” he said. When asked about his takeaways from the project, Mr. Ndai cited "the amount of dedication, resources, and commitment my institution put into this small but important population of patients so that everyone receives the best possible care.”
“A key to implementing quality improvement projects at an institution, particularly for hematology initiatives, is having a champion or support from leadership,” said session co-chair Ming Y. Lim, MBBCh, MS. “This backing can provide the necessary resources, visibility, and motivation to drive the project forward and ensure its success.”
While basic science and clinical trial research are essential drivers of medical advancement, there are often significant barriers to translating this knowledge into bedside care. All three of this year’s ASH Quality Improvement Champions recognized the need to bridge this gap, working collaboratively within their institutions to bring clinical research and guidelines to practice. The road to better patient outcomes in hematology is paved with continuous quality improvement, where data, collaboration, and innovation meet! Interested in becoming an ASH Quality Improvement Champion? Contact [email protected] to get started.
