Inappropriate or unnecessary thrombophilia testing remains a frequent problem in the hospital inpatient setting, leading to significant financial ramifications and the potential for adverse medical care, according to research presented at the 2016 ASH Annual Meeting and Exposition.
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Hospitalized patients commonly undergo thrombophilia testing. However, many physicians have questions the necessity of these tests, particularly due to their high costs and inconclusive utility due to potential confounding factors.
Eric Mou, MD, resident physician at Stanford University School of Medicine (Stanford, CA), and colleagues retrospectively reviewed all inpatient thrombophilia testing ordered at their institution during a 1-year period. The researchers used evidence-based data and medical society guidelines to determine testing appropriateness. Test orders were linked to the ordering physicians’ primary services.
The study included data on 889 tests ordered for 167 patients from 20 medical services. Mou and colleagues deemed 37.2% test orders (n = 331) inappropriate, which represented a cumulative hospital cost of $152,923.
Antithrombin III testing was most frequently ordered inappropriately (94.4%), followed by factor V Leiden (93.2%), protein C (92.7%), protein S (92.2%), and prothrombin G20210A mutation testing (89.3%).
The most commonly observed reasons for inappropriate testing included individual tests ordered in the setting of clearly provoked thrombotic events, tests ordered during the acute thrombotic period, tests ordered for patients on concurrent anticoagulation, and tests with results that failed to impact management of care.
When stratified by department, general medicine (38.1%) and neurology (34.9%) ordered inappropriate thrombophilia testing at the highest rates, whereas the lowest ordering rates occurred in the departments of hematology (15.9%) and rheumatology (12.8%). Non-teaching services inappropriately ordered testing at a rate of 62.2%, although their volume of ordering remained lower that other high-ordering services.
“Even when thrombophilia testing results fail to impact short term decision-making, misappropriated labeling of patients as ‘thrombophilic’ can have a lasting negative impact on future anticoagulation decisions,” wrote Mou and colleagues. “Combined with the high cost of errant ordering, these serve as a strong impetus to reduce the rate of thrombophilia testing during inpatient hospitalizations. Our baseline data demonstrate a need for institution-wide changes such as implementing electronic best practice advisories or potential ordering restrictions, and of tantamount importance, service-specific educational interventions in order to reduce unnecessary expenditures and improve patient care."
