title: Reducing inpatient heritable thrombophilia testing using a clinical decision-making tool.
abstract: OBJECTIVE
  To evaluate the impact of a clinical decision-making tool, designed to educate physicians regarding heritable thrombophilia (HT) testing, on the volume of testing in hospitalised patients in the tertiary care setting.
  
  
  METHODS
  We performed a retrospective cohort study over a 6-year period (2007-2012) at a single tertiary care centre intervention site and two regional control sites. In January 2010, the intervention site instituted a policy change whereby physicians ordering HT testing on inpatients needed to complete a pre-preprinted order (PPO) form that outlined the limitations of HT testing in the hospitalised setting. Failure to complete the PPO within 24 h resulted in test cancellation. Our main outcome measure was the volume of HT testing performed at the three study sites.
  
  
  RESULTS
  Introduction of the PPO resulted in a 79.4% (95% CI 71.2% to 87.6%) reduction in factor V Leiden (FVL) testing at the intervention site. This decrease was significantly greater compared with those in the two control teaching hospitals over the same time periods (33.7% and 43.6%; both p<0.001). Reductions in FVL testing postintervention were observed among all ordering specialists. Similar postintervention reductions in testing volumes were observed for antithrombin (57.4%), protein C (61.9%) and protein S (62.2%) activity assays.
  
  
  CONCLUSIONS
  In a large tertiary care hospital, the introduction of a clinical decision-making tool significantly reduced HT testing in inpatients across clinical specialties. The impact on patient outcome should be assessed in further studies.
authors.affiliation: Department of Medicine, University of British Columbia, , Vancouver, British Columbia, Canada.
authors.forename: Tyler W
authors.initials: TW
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Pi
authors.forename: Monika
authors.initials: M
authors.lastname: Hudoba
authors.forename: Agnes Y Y
authors.initials: AY
authors.lastname: Lee
mesh_terms: D001955:British Columbia; D015331:Cohort Studies; D003657:Decision Making; D055317:Evidence-Based Practice; D005165:Factor V / Q000235:genetics; D005820:Genetic Testing / Q000191:economics / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D019851:Thrombophilia / Q000175:diagnosis* / Q000191:economics / Q000235:genetics
chemical_list: C095381:factor V Leiden; D005165:Factor V
keywords: CLOTTING; LABORATORY MANAGEMENT; LABORATORY TESTS; THROMBOPHILIA; THROMBOSIS