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Becky Zon, MD




Clinical Fellow




Hematology/Oncology Clinical Fellow




Rebecca Zon MD*, Katelyn W. Sylvester PharmD, David Rubins MD, Jessica Grandoni PharmD, Rajesh Patel MD MPH, Jean Connors MD

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

I have always been dedicated to promoting gender diversity in medicine. I led the Women in Medicine group in residency, am currently the fellow liaison of the MGH Women in Oncology group, and recently hosted episodes on Women in Hematology for the American Society of Hematology podcast series. It would be an honor to participate in the WMSS, as this is an incredible avenue that promotes and highlights the amazing research being done by women. The WMSS sponsors collaboration and is perfectly aligned with my passion to create forums where women in medicine can support one another.


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


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 <4.  Interventions were assessed in pre and post implementation time periods from 12/17/2017 to 4/24/2021. Chi-squared analysis was performed between groups. 


Heparin discontinuation increased from 35% to 46% (p = 0.015) after BPA implementation. In the pre-4T order questions group, 4T scores were documented in 30% (85/272) compared to 100% (547/547) in the post-4T group. In the pre-4T group, only 27% of PF4 tests were appropriate.​ No change in appropriate PF4 ordering was seen with the randomized BPA: 81% appropriate orders with the BPA versus 76% without (p=0.13).  Subspeciality appropriate PF4 test ordering varied.


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.

Figure 1. Best Practice Advisory recommending discontinuation of heparin when ordering PF4 testing 
Figure 2. Heparin discontinuation before and after Best Practice Advisory (BPA) recommending heparin discontinuation.