Enhancing coagulopathy management in cancer patients: A quality initiative in thromboelastography interpretation for internal medicine and emergency medicine residents.

463 Background: Thromboelastography (TEG) is a whole blood assay that provides dynamic management of coagulopathic states, particularly in cancer patients who frequently experience complex coagulation abnormalities. Despite its clinical utility in oncology, interpreting TEG can be challenging without structured education. We initiated a quality improvement project to enhance TEG interpretation skills among Internal Medicine/Medicine-Pediatrics (IM) and Emergency Medicine (EM) residents through a low-cost, multimodal intervention. Methods: Following the institutional review board's approval, we implemented a simplified "Rule of 6s" poster in resident work areas for four weeks. After obtaining informed consent, residents completed a baseline questionnaire using a five-point Likert scale to evaluate TEG-related knowledge, attitudes, and practices. A targeted, interactive teaching session was then delivered by a TEG expert attending, followed by another four-week assimilation period. A post-intervention survey was administered using the same tool. An honest broker matched the responses, and statistical analysis was performed with significance set at p<0.05. Results: Of 46 residents completing the pre-intervention survey [25 (54.35%) IM and 21 (45.65%) EM], 19 [10 (52.63%) IM and 9 (47.37%) EM] completed both surveys. Respondents were distributed evenly across PGY levels. The matched analysis demonstrated significant improvement in residents' comfort with ordering (median 2-4, p=0.0004), reading (median 2-4, p<0.0001), and treating patients based on TEG (median 2-4, p=0.0003), as well as in recognizing TEG’s utility in coagulopathic states (median 3-4, p=0.0361) and in suspected disseminated intravascular coagulation (median 3-4, p=0.0083). There was no significant improvement in the knowledge items, which tested advanced interpretation using clinical vignettes, after targeted interventions (p>0.05). Conclusions: Though skill gaps persist, a targeted, low-cost educational intervention significantly improved residents' basic knowledge, attitudes, and self-reported practices regarding TEG use. These findings highlight the continuing need for structured TEG education in residency training. In response to these results, we created a multidisciplinary TEG task force to provide ongoing education and support for TEG interpretation. Limitations include a small sample size and a modest response rate. Future efforts should expand the reach and include objective assessments of TEG interpretation skills.