Establishing a rapid-response multidisciplinary service for thrombotic microangiopathies using a model of improvement framework: perspectives from a Brazilian quaternary hospital

Thrombotic microangiopathies (TMA) require prompt identification and coordinated treatment because they are associated with substantial morbidity, irreversible target-organ injury, and mortality. Yet fragmented diagnostic and care pathways often delay diagnosis and lead to poorer outcomes. This Perspective article describes the design and implementation of a TMA Center of Excellence at a Brazilian quaternary hospital. This initiative aimed to design and implement a rapid-response, multidisciplinary TMA service to shorten diagnostic and treatment delays, standardize diagnosis-specific care, and establish prospective measures to evaluate clinical and operational performance. Rather than reporting outcomes, we highlight design choices, stewardship safeguards for high-cost therapies, and practical implementation enablers. Multidisciplinary teams designed and tested diagnostic and therapeutic workflows using iterative Plan-Do-Study-Act cycles. Care pathways tailored to specific patient populations were embedded into the electronic medical record (EMR). EMR integration enabled real-time alerts triggered by key laboratory results, while embedded tools, such as the PLASMIC score (platelet count, hemolysis, no active cancer, no history of solid-organ or stem-cell transplant, mean corpuscular volume, international normalized ratio, and creatinine) and therapy-specific prescription menus, guided clinical decisions. A structured indicator framework was developed to prospectively monitor time to diagnosis, adherence to clinical pathways, length of stay, and intensive care utilization. Interdisciplinary collaboration facilitated alignment across emergency, radiology, laboratory, nephrology, and hematology services. This quality improvement strategy supports the feasibility of implementing a comprehensive, multidisciplinary model for TMA management and offers a transferable blueprint that middle-income health systems can adapt.