The impact of physician education regarding the importance of providing complete clinical information on the request forms of thrombophilia-screen tests atTygerberg hospital in South Africa.

Ibtisam Abdullah,Zivanai C Chapanduka,Andrea D Jafta

doi:10.1371/journal.pone.0235826

Ibtisam Abdullah, Zivanai C Chapanduka + Show 1 more

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https://doi.org/10.1371/journal.pone.0235826

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Abstract

BackgroundThrombophilia-screen tests are specialised haemostasis tests that are affected by numerous unique patient variables including the presence of acute thrombosis, the concomitant use of medication and patient demographics. Complete information on the request form is therefore crucial for the haematological pathologist to make patient-specific interpretation of patients’ results.ObjectivesTo assess the completeness of thrombophilia-screen test request forms and determine the impact of provision of incomplete information, on the interpretive comments generated by reporting haematological pathologists. To assess the impact of an educational session given to clinicians on the importance of providing all the relevant information on the request forms.MethodTwo retrospective audits, each covering 3 months, were performed to evaluate the completeness of demographic and clinical information on thrombophilia-screen request forms and its impact on the quality of the interpretive comments before and after an educational intervention.ResultsOne hundred and seventy-one request forms were included in the first audit and 146 in the second audit. The first audit revealed that all 171 thrombophilia-screen request forms had complete patient demographic information but none had clinical information. Haematological pathologists only made generic comments which could not be applied to a specific patient. The second audit, conducted after a physician educational session, did not reveal any improvement in the clinical information provision by the test-ordering physicians. This was reportedly due to the lack of space on the request form. The interpretive comments therefore remained generic and not patient-specific.ConclusionPhysicians’ failure to provide relevant clinical information made it impossible for pathologists to make patient-specific interpretation of the results. A single physician education session did not change the practice, reportedly due to the inappropriate design of the test request form. Further studies are required to investigate the impact of an improved request form and the planned electronic test requesting.

Highlights

Thrombophilia-screen tests are requested in a select group of patients presenting with venous thromboembolism (VTE) to predict the likelihood of recurrence of thrombosis and to decide on the duration of anticoagulation therapy
Haematological pathologists only made generic comments which could not be applied to a specific patient
The second audit, conducted after a physician educational session, did not reveal any improvement in the clinical information provision by the test-ordering physicians. This was reportedly due to the lack of space on the request form

Summary

Introduction

Thrombophilia-screen tests are requested in a select group of patients presenting with venous thromboembolism (VTE) to predict the likelihood of recurrence of thrombosis and to decide on the duration of anticoagulation therapy. [1] Anticoagulation therapy carries the risk of bleeding and increases patient morbidity and health care costs. Anticoagulation therapeutic agents are influenced by multiple factors including patient genomics, the concomitant use of other therapeutic drugs and diet. Other variables to consider include underlying infections, liver disease, renal dysfunction, obstetric history, the presence of acute thrombosis and additional concomitant medication.[4]. Thrombophilia-screen tests are specialised haemostasis tests that are affected by numerous unique patient variables including the presence of acute thrombosis, the concomitant use of medication and patient demographics. Complete information on the request form is crucial for the haematological pathologist to make patient-specific interpretation of patients’ results

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