Becky Zon, MD

Pronouns

She/Her/Hers

Job Title

Fellow

Academic Rank

Research Fellow

Department

Medicine

Authors

Rebecca Zon MD, Katelyn W. Sylvester PharmD, David Rubins MD, Jessica Grandoni PharmD, Rajesh Patel MD MPH, Jean Connors MD, Mark Akladious, Shreya Timilsina PharmD, Julie Kelly PharmD

Principal Investigator

Jean Connors

Research Category: Other

Implementation of Electronic Decision Support Tools to Improve Diagnosis and Management of Heparin Induced Thrombocytopenia

Scientific Abstract

Background: Heparin-induced-thrombocytopenia (HIT) is a life-threatening disorder. Clinicians caring for patients at risk are often unaware how to diagnose and manage HIT.

Methods: We implemented tools at Brigham and Women’s Hospital to improve management of suspected HIT cases: 1. Best Practice Advisory (BPA) encouraging heparin discontinuation when ordering Platelet Factor 4 (PF4) testing (Figure 1), 2. Questions requiring 4T calculation when ordering a PF4, 3. Randomized BPA recommending discontinuing the PF4 order if 4T score

Results: Heparin discontinuation increased from 35% to 46% (p = 0.015) after electronic tool implementation. More providers also calculated the HIT likelihood score. However, despite calculating the score, there was no change in inappropriate test ordering.

Conclusion: Implementation of electronic decision support to stop heparin in patients with suspected HIT was successful, which can decrease mortality, but improving appropriate PF4 test ordering was not affected by similar strategies.

Lay Abstract

Background: Heparin-induced-thrombocytopenia (HIT) is a life-threatening disorder that can occur in patients treated with heparin. This condition occurs in up to 5% of those treated with heparin products and leads to dangerously low platelet counts and blood clots. One crucial aspect of treating HIT is to stop heparin products when this diagnosis is being considered.

Methods: We implemented tools at Brigham and Women’s Hospital to improve management of suspected HIT cases through adding tools in the electronic medical record. For patients with clinical concern for HIT, these tools included 1. a calculation that provides the likelihood that the patient has HIT, 2. a recommendation to discontinue inappropriate orders if the likelihood of HIT diagnosis is low, and 3. a recommendation to stop heparin products when the diagnosis is being considered.

Clinical Implications

Implementation of electronic decision support tools can improve care in patients with heparin-induced thrombocytopenia by increasing heparin discontinuation, which if not done appropriately can be life-threatening.

Implementation of Electronic Decision Support Tools to Improve Diagnosis and Management of Heparin Induced Thrombocytopenia

Scientific Abstract

Lay Abstract

Clinical Implications

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