Background: The American Society of Hematology (ASH) advises against routine thrombophilia testing in hospitalized patients with new venous thromboembolism (VTE) due to the potential for inaccurate results during the acute phase of the disease. Thrombophilia testing is generally reserved for outpatient follow-up, once the acute event has resolved. However, testing may be appropriate in specific clinical scenarios, such as when antiphospholipid syndrome (APS) is suspected. The cost of thrombophilia panels can range from $1,100 to $2,400, depending on the laboratory. Retrospective data from our safety-net urban hospital indicate that from May 2023 – June 2024 395 thrombophilia workup tests were ordered by internal medicine residents. This study aims to assess and improve internal medicine residents’ knowledge of appropriate thrombophilia testing in the inpatient setting.
Methods: A pre-test questionnaire was distributed to internal medicine residents to assess their baseline knowledge regarding appropriate thrombophilia workup in hospitalized patients, as well as their understanding of APS diagnosis and management. Afterwards, a 60-minute lecture on these topics was delivered by a hematologist. Following the lecture, residents engaged in 20-minute small group discussions facilitated by the study team. To evaluate knowledge retention and learning outcomes, a post-test questionnaire was administered immediately after the educational interventions. The pre- and post-test results were compared using a paired t-test, with statistical significance defined as a p-value of < 0.05.
Results: A total of 54 residents participated in the educational intervention and completed the pre- and post-tests. Key areas of knowledge improvement included correct timing for thrombophilia workup and the identification of patient scenarios that would warrant inpatient testing. 96.3% of residents correctly answered questions regarding appropriate inpatient thrombophilia testing and most residents could correctly answer clinical (88.9%) and laboratory criteria (83.3%) of APS. The average test scores increased significantly from 53.0% to 81.9% following the educational intervention with a p-value of < 0.001.
Conclusions: Analysis of pre- and post-test data revealed a statistically significant improvement in residents’ understanding of appropriate thrombophilia testing and APS management. While the study demonstrated significant improvements in knowledge immediately following the intervention, maintaining and reinforcing this knowledge over time is essential for long-term retention. We plan to implement quarterly educational sessions focused on appropriate thrombophilia testing, complemented by additional coverage of these topics during night float shifts. During these shifts, a study team member will facilitate case-based discussions to reinforce key concepts and encourage practical application in real-world scenarios. Our next planned intervention is a best-practice advisory in EMR that will alert an ordering provider of ASH recommendation against inpatient thrombophilia testing for VTE patients. Our hope is that these interventions will keep clinicians aligned with current guidelines and best practices, ultimately enhancing patient care by reducing unnecessary testing and associated healthcare costs.