Quality Improvement Principles Research Articles

1074-P: Multicenter Quality Improvement Project—Increasing Social Determinants of Health (SDOH) Screening across Six Diabetes Centers in the United States

Background: Social Determinants of Health (SDOH) are strongly associated with outcomes for patients with diabetes. Incorporating widespread clinic SDOH screening programs is challenging. We aim to demonstrate the use of Quality Improvement (QI) interventions in expanding SDOH screening practices across 5 pediatric and 1 adult diabetes center in the T1D Exchange Improvement Collaborative (T1DX-QI). Method: The centers applied QI principles to design iterative plan-do-study-act (PDSA) cycles to develop and expand interventions to improve screening rates. The interventions include staff training, creating a social risk index, using EHR patient-facing portal, partnership with community organizations, referral to clinic, and community resources. The centers shared monthly aggregate data with the coordinating center. Statistical Process Control charts were created and analyzed for significant shifts. Result: All centers successfully implemented SDOH screening, and improvement ranged from 41% to 68%. Overall screening increased from baseline by 56% in 24 months. Disclosure O.Odugbesan: None. E.J.Hess: None. N.Rioles: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T.Wright: None. N.Yayah jones: Consultant; Medtronic. M.Gallagher: None. J.Ilkowitz: None. S.A.Dei-tutu: None. E.L.Dewit: None. R.Izquierdo: None. M.Desimone: None.

Career decisions, training priorities, and perceived challenges for anesthesiology residents in the United States

Study objectiveThis study sought to understand the timing and important factors identified by residents regarding their decision to pursue a career in anesthesiology, training areas deemed important to their future success, perceived greatest challenges facing the profession of anesthesiology, and their post-residency plans. DesignThe American Board of Anesthesiology administered voluntary, anonymous, repeated cross-sectional surveys to residents who began clinical anesthesia training in the U.S. from 2013 to 2016 and were subsequently followed up yearly until the completion of their residency. The analyses included data from 12 surveys (4 cohorts from clinical anesthesia years 1 to 3), including multiple-choice questions, rankings, Likert scales, and free text responses. Free responses were analyzed using an iterative inductive coding process to determine the main themes. Main resultsThe overall response rate was 36% (6480 responses to 17,793 invitations). Forty-five percent of residents chose anesthesiology during the 3rd year of medical school. “Nature of the clinical practice of anesthesiology” was the most important factor influencing their decision (average ranking of 5.93 out of 8 factors, 1 [least important] to 8 [most important]), followed by “ability to use pharmacology to acutely manipulate physiology” (5.75) and “favorable lifestyle” (5.22). “Practice management” and “political advocacy for anesthesiologists” (average rating 4.46 and 4.42, respectively, on a scale of 1 [very unimportant] to 5 [very important]) were considered the most important non-traditional training areas, followed by “anesthesiologists as leaders of the perioperative surgical home” (4.32), “structure and financing of the healthcare system” (4.27), and “principles of quality improvement” (4.26). Three out of 5 residents desired to pursue a fellowship; pain medicine, pediatric anesthesiology, and cardiac anesthesiology were the most popular choices, each accounting for approximately 20% of prospective fellows. Perceived greatest challenges facing the profession of anesthesiology included workforce competition from non-physician anesthesia providers and lack of advocacy for anesthesiologist values (referenced by 96% of respondents), changes and uncertainty in healthcare systems (30%), and personal challenges such as psychological well-being (3%). ConclusionsMost residents identified anesthesiology as their career choice during medical school. Interest in non-traditional subjects and fellowship training was common. Competition from non-physician providers, healthcare system changes, and compromised psychological well-being were perceived concerns.

Preoperative and postoperative optimisation of patients undergoing thyroid surgery: a multicentre quality improvement project at Barts Health NHS Trust

Hypocalcaemia following thyroid surgery can occur in up to 38% of patients. With over 7100 thyroid surgeries performed in 2018 in the UK, this is a common postoperative complication. Undertreated...

Clinical and epidemiological profile of ST-segment elevation myocardial infarction patients in a megacity of west of Iran.

Low- and middle-income nations account for at least three-quarters of cardiovascular disease deaths worldwide. This study aimed to obtain real knowledge about ST segment elevation myocardial infarction (STEMI) patients and provide the context for developing a principles for care quality improvement. This cross-sectional study was conducted from July 2018 through December 2019. The study sample consisted of1169 eligible patients based on inclusion criteria. The data were collected using the standard EROP and three specialized, trained questionnaires. The collected data were checked by the quality control officer and analyzed using Stata Version 14. Patient baseline characteristics showed that body mass index, low-density lipoprotein, high-density lipoprotein, total cholesterol, and triglyceride levels were higher in women. Also, females recorded a considerable history of diabetes mellitus, hypertension, and hypercholesterolemia compared to men. The results also showed that most men were smokers (46.80%). Aspirin (94.27%), statins (91.48%), and clopidogrel (90.68%) were the common medications used at hospital discharge for patients. The present study suggests that identifying and managing modifiable risk factors can improve cardiovascular disease outcomes. Also, considering the early identification of STEMI patients with new therapies can effectively decrease the rate of cardiovascular disease and its attributed health outcomes.

Monitoring of Non-communicable Diseases in a Primary Healthcare Setting in India: A Quality Improvement Initiative.

Background The majority of patients with non-communicable diseases (NCDs) seek care in a primary healthcare setting. There is a lack of effectivemonitoring of patients with NCD, whichleads to poor disease control and an increase in morbidity and mortality. We wanted to explore the feasibility of maintaining patient health record and utilising it for disease monitoring in a primary healthcare setting.Therefore, we aimed to increase the availability of patient health records from 0% to 100% using the principles of quality improvement (QI) among patients with hypertension and/or diabetes within six weeks and to use these records for assessingthe disease control status of patients through cohort monitoring approach. Methods This QI initiative was conducted at an urban health centre (UHC) located at Dakshinpuri, New Delhi. We specifically focused on two major NCDs: diabetes and hypertension. We formed a QI team and identified the gaps using fishbone analysis and a process flow diagram.We used the model for improvement and the Plan-Do-Study-Act (PDSA) framework.We conducted repeated rapid PDSA cycles for the designed intervention and monitored the change every week using a run chart. The data from the patient health record were entered into Microsoft Excel (Microsoft® Corp., Redmond, WA) using Google Forms (Google, Inc., Mountain View, CA) and Epicollect5 (Oxford Big Data Institute, Oxford, England).We used the cohort monitoring approach of the India Hypertension Control Initiativeto assess the quarterly control rate for hypertension and diabetes at the UHC. Results The root cause analysis revealed that the lack of a policy for keeping patient records and the lack of perceived need in the past were the primary reasons behind the absence of NCD health records. In brainstorming sessions with the QI team, we designed a paper-based patient health recordsystem involving unique identity (ID) generation, an index register, an NCD record file and an NCD passbook (Dhirghayu card) for each patient. We reorientated the process of patient flow and devised a mechanism for record-keeping at the UHC. This initiative increased the availability of patient health records from 0% to 100% in the initial three weeks. The system of maintaining patient health records was well received by the patients and was better utilised by treating physiciansfor NCD management. After the intervention, we were able to use the data from the NCD file toassess the quarterly control ratesof the patients with hypertension and/or diabetes. Conclusion Our study showed that patients'health records can be generated and maintained in a primary healthcare setting by using the principles of quality improvement. These records can be utilised for the disease monitoring of patients with hypertension and/or diabetes, which can lead to better disease control. The sustainability of this initiative and the performance of the health facility can be assessed in future studies using annual control rates.

Building Resident Quality Improvement Knowledge and Engagement Through a Longitudinal, Mentored, and Experiential Learning-Based Quality Improvement Curriculum.

Quality improvement (QI) training is an essential component of resident medical education and a part of the ACGME core competencies. We present our residency's evidence-based QI curriculum, which outlines key components identified in the literature for successful QI education. Our curriculum included a mandatory five-part longitudinal educational series during ambulatory education sessions for second-year residents. Modeled after the Institute for Healthcare Improvement model for improvement and taught by a chief resident, our curriculum introduced residents to key QI concepts through case-based, just-in-time didactics and applied experiential learning via concurrent resident-led longitudinal QI projects. Residents received structured, multilayer mentorship from a faculty mentor in their field of interest and the chief resident of quality and patient safety. Their work-in-progress projects were presented to faculty QI experts and institutional leadership for additional feedback and mentorship. Since 2016, a total of 234 internal medicine residents have completed our QI curriculum and developed 67 QI projects, which have been presented at various local, regional, and national conferences. In the 2 most recent academic years, Quality Improvement Knowledge Application Tool Revised (QIKAT-R) scores significantly increased from 4.6 precurriculum to 6.3 postcurriculum (p < .001). A longitudinal, experiential, and mentored QI curriculum teaches residents QI skill sets through incorporating mechanisms associated with successful educational initiatives and adult learning theory. Our QIKAT-R results and project output show that our curriculum is associated with improved trainee QI knowledge and systems-level improvements.

Interactive Patient Safety and Quality Improvement capstone during transition-to-residency program: virtual and in-person focused workshop for EPA 13

Identifying systems failures and contributing to a safety culture is the Association of American Colleges (AAMC’s) thirteenth Entrustable Professional Activity (EPA). While most curricula teach Patient Safety (PS) and Quality Improvement (QI) principles, student participation in live QI/PS activities remains limited. This workshop enabled late Clerkship phase students to apply these Health Systems Science (HSS) principles to real adverse patient event cases through team-based simulation.This 3-h capstone included both a didactic review of QI, PS, and TeamSTEPPS® tools and an experiential component where student-led interactive small group discussions were augmented by resident and faculty preceptors. Collaboratively, students composed an adverse patient event report, conducted a Root Cause Analysis (RCA) during role-play, and proposed error prevention ideas after identifying systems problems. In April 2020, the in-person workshop became fully virtual due to the COVID-19 pandemic.A statistically significant increase in ability to identify Serious Safety Events, Escalation Chain of Command, and define a Plan-Do-Study-Act (PDSA) cycle was observed. Comfort with RCA increased from 48 to 87% and comfort with TeamSTEPPS® principles increased from 68% to 85.5%This novel capstone provided students with the tools to synthesize HSS concepts through problem-solving processes and recognize EPA 13’s importance. Their increased capability to identify appropriate chain of command, escalate concerns, and recognize serious adverse patient events also has training and practice readiness implications.

Implementation science for quality improvement in pediatric surgery

Despite the widespread integration of quality improvement principles into pediatric surgical practice, the actual adoption of evidence-based practices continues to be a challenge. The field of pediatric surgery, in particular, has been slow to adopt clinical pathways and protocols that lead to decreased practice variation and improved clinical outcomes. This manuscript provides an introduction to how implementation science principles into quality improvement efforts may optimize uptake of evidence-based practices, ensure success of these endeavors, and help assess the effectiveness of the interventions. Examples of implementation science application to pediatric surgical quality improvement endeavors are explored.

Outcomes in pulmonary sarcoidosis: results of a newly implemented prednisone protocol.

Background and aim Prednisone is used as first-line therapy for patients with pulmonary sarcoidosis. There is however no clear association between prednisone dose and FVC change in patients with pulmonary sarcoidosis. In order to improve our standard of care we introduced a more conservative prednisone protocol. Methods This study is a single centre observational study, applying value-based healthcare (VBHC) and quality improvement (QI) principles. Prednisone intake was reduced from a starting dose of 40 mg to a starting dose of 20 mg. Primary outcomes evaluated were FVC, FEV1 and DLCO % predicted. The secondary outcome measure was BMI. Results 369 patients were included in the old-cohort and 215 in the new-cohort. In the old-cohort, 182 (49.0%) of the patients were treated with prednisone. In total, 114 patients (62.6%) were treated according to the old protocol with a mean initial prednisone dose of 32.1 ±14.2 mg. In the new-cohort, 93 patients (45.0%) were treated with prednisone of which 53 patients (57.0%) received prednisone according to the new protocol. The mean initial prednisone dose in the new-cohort was 21.4 ±9.8 mg. Changes in FVC and FEV1 % predicted did not vary. Change in % predicted DLCO was 2.4 ±9.3 for the old-cohort and -1.3 ±11.4 for the new-cohort (p = 0.01). No statistically significant changes in BMI were observed. Conclusions Our results indicate that in more than half of the patients the new protocol was followed. Data support the observation that a more conservative prednisone regimen might be equally effective, looking at changes in pulmonary function and BMI.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

An introduction to quality improvement

The concept of quality has moved to the top of the international healthcare agenda in the past 30 years. This has been driven by a growing awareness of the scale of variation in patient outcomes, influenced by both the paucity of and consistency in implementation of evidence-based actions or interventions performed during the delivery of patient care. Concurrently there has been growing interest on the part of healthcare professionals to use a wider range of knowledge and available techniques, from outside of medicine, to continuously improve standards of safe and effective patient care. This is the first in a series of three articles introducing Quality Improvement (QI) methodology and supporting concepts to multidisciplinary teams working in Urology departments in the United Kingdom. We start, in this article, by providing an overview of key QI principles and their industrial roots; we position QI in the context of other approaches to improvement, such as audit, and we outline the key organisations and infrastructure supporting QI work on the ground.

Continuous quality improvement in peritoneal dialysis: Your questions answered.

Peritoneal dialysis (PD) uptake around the globe has steadily increased over the last several decades as a viable alternative to haemodialysis. Continued success of this technique for patients is contingent on the application of continuous quality improvement (CQI) principles in PD practice which can improve patient outcomes and in turn lead to more successful PD programmes worldwide. In this installation of 'Your Questions Answered', we will outline an approach to quality improvement initiatives and examine the importance of CQI principles in PD practice. We will also highlight common pitfalls and provide strategies to identify potential targets for improvement within your PD programme.

A narrative inquiry into healthcare staff resilience and the sustainability of Quality Improvement implementation efforts during Covid-19

BackgroundRecent research, which explored the use of Quality Improvement (QI) methods in the Covid-19 pandemic response, found that Quality Improvement principles were utilised during the crisis management period, albeit without direct intention. Following on from this work, the aim of this paper extends that study by investigating the sustainability and resilience of not only the changes implemented by healthcare staff during Covid-19 in Ireland, but the resilience of the wellbeing of healthcare staff themselves through the various waves of Covid-19.MethodsTo explore healthcare staffs experience of Quality Improvement and the sustainability and resilience of both Quality Improvement initiatives and healthcare staff, a qualitative design was implemented. Semi-structured interviews took place online over Zoom with 11 healthcare staff members from the Irish healthcare service in the Spring of 2022. An analysis of the narratives was conducted using thematic analysis supported by NVivo12.ResultsFour key themes were evident from the data: (i) From fear to exhaustion; (ii) maintaining person-centred approaches to care; (iii) Covid-19 as a medium for change, and; (iv) staff resilience and appetite for Quality Improvement.DiscussionThe results of this work identified three key learnings; (i) integrating learning into policies and practice: (ii) the role of collective leadership and devolving/sharing power; and (iii) key drivers/factors that promote sustainability of QI interventions. Despite the challenges in recruitment of research participants experienced during the pandemic, a narrative approach supported the collation of rich and nuanced insights into the experiences of healthcare staff during this time.ConclusionA growing body of literature currently exists on how healthcare staff felt during the Covid-19 pandemic. However, as the waves of Covid-19 have declined, it is vital to examine how the feelings of burnout and disillusionment will affect engagement with Quality Improvement in the future. It is also worth noting and examining the feeling of purpose and pride participants expressed from working through the Covid-19 pandemic. This study has helped to address this gap.

The Balancing Act of Clinical Leadership: Lessons Learned from the COVID-19 Pandemic

The COVID-19 pandemic disrupted the world of leadership. Every healthcare professional—front-line staff and leaders alike—adapted their work to confront this virus. The contributions of clinical leaders during the COVID-19 pandemic are unique and important. Experiences of clinical leadership reinforce the critical nature of leadership strategy, quality improvement principles, and commitment to integrated, whole-system quality. Clinical leaders, possessing the dual responsibility of front-line care and system-level leadership, hold critical insights regarding change in healthcare organizations as a whole. In their pandemic response, clinical leaders demonstrated key leadership characteristics that required individual growth and facilitated team cohesion: communicating with consistency and humanity; being the first to try; attending to burnout and moral injury; and building bridges to strengthen the overall response. John Kotter’s landmark book, Leading Change, provides an anchoring framework for examining the experiences and strategies of clinical leaders during the COVID-19 pandemic.

Curricular Revision to Increase Use of Quality Improvement Principles in Doctor of Nursing Practice Projects

BackgroundA gap was identified related to students’ use of quality improvement (QI) methodologies in their final project, so a curricular change was made to incorporate a health care QI methods course in the curriculum. MethodsWe compared the use of SMART (specific, measurable, achievable, relevant, and time-bound) aims and QI evaluation methodologies in doctor of nursing practice (DNP) project proposals in 2 cohorts before and after the curriculum change. ResultsA total of 88 DNP proposals were evaluated. ConclusionIncluding a QI course increased the use of SMART aims but did not influence the use of QI methodologies. Future interventions will target faculty development related to QI.

SG-APSIC1036: Effect of quality improvement in medical devices preparation on increasing customers’ satisfaction in services of the Central Sterile Supply Department of Srinagarind Hospital

Objectives: Preparation of medical devices from central sterile supply department (CSSD) for use in hospital services requires quality and readiness for use. A guideline for good practice is necessary for safety, assurance, and maximum customer satisfaction, and to accommodate effective healthcare services. We sought to develop and improve medical-device preparation guidelines to satisfy clients. Methods: This action research was based on the concepts of Kaizen and eliminate–combine–rearrange–simplify (ECRS). The research was conducted in 3 phases. In the first phase, we designed the study, conducted problem analysis, and developed a plan for improving the preparation of medical devices. In the second phase, we improved the plan for implementation of medical-device preparation guidelines that the research team adapted and developed. We added inspection categories, trained staff members, conducted a focus group. We improved cleaning processes and the inventory system. In the third phase, we conducted an improvement evaluation for (1) quality improvement of medical device preparation and (2) client satisfaction. The research took place from January to December 2019. Results: The monthly percentages of medical equipment that passed quality criteria before and after the implementation plan were 91.82±1.19% and 95.33±1.25% (P ≤ .005). The average client satisfaction score increased from 76.80% to 83.40% (P = .006). Conclusions: The implementation of Kaizen and ECRS principles for quality improvement successfully increased the quality of equipment preparation and introduced standardized, quality guidelines. The plan–do–check–act (PDCA) process improved client satisfaction, staff performance, and operational efficiency while preventing damage to medical devices and improving readiness of use.

Shared governance council to engage advanced practice registered nurses in a hospital setting.

Health care organizations use advanced practice registered nurses (APRNs) to expand patient access and support high-quality care. However, turnover, often exacerbated by inadequate engagement, has steep financial and experiential costs. The project site, a large urban academic institution with quaternary care capabilities, employs more than 300 APRNs to provide patient care. Due to variations in hiring entity, leadership structure, and organizational visibility, efforts to maintain APRN engagement were complex. In addition, inconsistencies in standardization of clinical, credentialing, and privileging procedures created organizational risk. Quality improvement principles informed the implementation of a shared governance council for APRNs that included nurse practitioners and certified registered nurse anesthetists. Data were collected pre and postintervention using validated engagement questions. Implementation of a shared governance council to support the organizational engagement of APRNs through decisional involvement in professional practice issues. Analysis included the percentage of change in aggregate scores and the Wilcoxon rank-sum test to obtain p values of the 2 independent samples. There was an 8.9% increase in aggregate postintervention scores and statistical improvement in measures of quality improvement involvement. Participation in the shared governance council increased APRN engagement through enhanced opportunities to communicate professional and clinical practice issues, decisional involvement, and collaboration. Statistically significant improvements in quality improvement involvement values potentially affirm the council's role in facilitating work environment improvements. Potential long-term gains include improved job satisfaction, retention, and organizational cost savings.

Literature review: Improvement patient safety during the pandemic covid-19

Patient safety has been a major challenge for patient safety and healthcare systems over the past 20 years. In 1999 To Err Is Human by the Institute of Medicines raised public awareness about patient safety and described the potential for significant harm to patients. Evidence shows that despite concerted efforts to make health care safer unintentional harm by health care providers that seriously harms patients is still common. A 2016 study estimated that 140.400 deaths were caused by medical error in the United States making medical error the third leading cause of death in the United States and further emphasizing the need for improved patient safety. Healthcare systems around the world continue to take a treatable toll on patients. It is a preventable complication of care that accounts for 3.6% of acute hospital deaths in England. There are financial implications of poor care and negative outcomes. For example the UK Health Foundation says: Careful care is expensive. Unstable production systems; And costs can be reduced by providing reliable care. This review examines the goals of health reform and national efforts to create a culture of quality improvement and patient safety principles. And show how these principles can be applied to patient care and health care practice.

Increasing Inclusion, Diversity, Antiracism, and Equity With a Medical School Curriculum Quality Improvement Project.

The students at Mayo Clinic Alix School of Medicine (MCASOM) wrote a call to action to medical school leadership in June 2020. The students requested help in navigating socio-political barriers that affected one another and contributed to healthcare inequities and mistrust. Using the Association of American Medical Colleges (AAMC) tool to assess cultural competence training, our team evaluated the baseline 2017-2018 MCASOM curriculum. There were 254 learning objectives, of which 43 (17%) were related to inclusion, diversity, antiracism, and equity (I-DARE). Mirroring the concerns of the students, the findings identified minimal content about antiracism and inclusion. By applying DMAIC principles for quality and process improvement, we aimed to increase the number of taught learning objectives about I-DARE content for the first-year and second-year medical students by 100%, from 43 to 86 objectives, without adversely affecting student satisfaction and true attendance. To address the underlying causes, we launched a virtual, multisite I-DARE medical school course and doubled the number of I-DARE-taught learning objectives from 43 to 107 (149%), compared with the baseline. The program evaluation review revealed that the students were self-reflective and provided a spectrum of experiences regarding the I-DARE course.

A Multidisciplinary Quality Improvement Project to Improve Appropriate Inherited Thrombophilia Testing at VA Connecticut

Background Many guidelines and expert opinions do not recommend inherited thrombophilia testing in unselected patients with venous thromboembolism (VTE), and per American Society of Hematology Choosing Wisely Recommendations, inherited thrombophilia testing is not recommended in patients with venous thromboembolism occurring in the setting of major transient risk factors. Furthermore, non-hematologists may lack knowledge on the effect of direct oral anticoagulants on these assays. From 2019 to 2021, 75% of inherited thrombophilia testing (protein C, S and antithrombin deficiencies and Factor V Leiden and prothrombin mutations) at VA Connecticut were ordered by non-hematologists. Of these orders, 55% of tests were ordered by primary care clinicians, 29% by inpatient teams, and the remainder by non-hematology specialists. Approximately 10% of testing by non-hematologists had abnormal results, generating further hematology consults and workup. Given that testing has limited clinical utility and can result in unnecessary downstream healthcare use, there is a need to improve guideline concordant and appropriate thrombophilia testing by non-hematologists. Methods The aim of this multidisciplinary quality improvement project was to decrease the number of inherited thrombophilia tests ordered by non-hematologists at VA Connecticut by 25% six months after our intervention implementation. Quality Improvement (QI) principles were used to identify root causes, which included complexity of and confusion over appropriate patient selection for testing, a lack of awareness of potential false positives with active anticoagulant use, limitations of our electronic medical record system (EMR) to provide clinical decision support tools to triage testing or provide education, and more. After multidisciplinary stakeholder engagement and feedback from hematology, internal medicine, laboratory medicine, and clinical informatics, we established a best practice alert (BPA) for inpatient and outpatient inherited thrombophilia testing at the time of order entry. Our BPA notified the ordering clinician that inherited thrombophilia testing rarely impacts the choice or duration of anticoagulation and is not recommended for most patients. The BPA recommended that as an alternative, clinicians can consider a hematology electronic consult (e-consult) for guidance and education regarding appropriate patient selection for testing. Data was collected from our EMR seven months after intervention initiation and analyzed via Excel 365. A control chart was used to assess the outcome measure, which was the number of orders for inherited thrombophilia testing by non-hematology clinicians per month. Our balancing measure was the number of hematology e-consults for inherited thrombophilia per month. Institutional pricing was used to determine costs associated with testing and potential cost savings. Results After our BPA implementation in January 2022, the mean number of monthly inherited thrombophilia tests from January to July 2022 decreased to 7.6 tests from 13.3 tests in 2021. All 7 monthly test order numbers post-implementation were below the mean, consistent with a potential trend towards a special cause variation shift. Inpatient testing decreased from 40 total tests in 2021 to 7 tests since implementation. The average cost of testing per month decreased from $653 to $366 with an estimated $2004 saved after intervention implementation. The mean number of hematology e-consults for inherited thrombophilia related questions increased to 3.4 consults per month during the first five months of the intervention period from 2.5 consults per month in 2021. Conclusion A best practice alert in the EMR reminding clinicians about the limited role of inherited thrombophilia testing in unselected patients and the option for hematology e-consult for further specialist guidance was associated with a trend towards reduced inherited thrombophilia testing. Furthermore, there were decreased costs associated with testing without any substantial increase in workload for the hematology service. The BPA remains in place, and data collection and analysis are ongoing. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal