Presentation Details
| Electronic Medical Record Interventions In Reducing Inappropriate Testing For Heparin Induced Thrombocytopenia: Experience In A Large Teaching Hospital System Mukul Singal1, 2, Soon K.Low3, 4, Peter A.Kouides5, 6, Maura Wychowski6, Ronald L.Sham5, 6. 1Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA.2Hematology and Oncology Fellowship, Rochester General Hospital, Rochester, NY, USA.3Internal Medicine Residency Program, Rochester General Hospital, Rochester, NY, USA.4Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.5Mary M.Gooley Hemophilia and Thrombosis Center, Rochester, NY, USA.6Department of Hematology and Oncology, Rochester General Hospital, Rochester, NY, USA |
Abstract
Introduction Heparin induced thrombocytopenia (HIT) is a profoundly hypercoagulable state. Immunoassays detect anti-PF4/heparin antibodies have a high sensitivity but only modest specificity. Anti-PF4 ELISA testing is therefore only recommended in patients with sufficient pretesting probability of HIT to avoid erroneous over-diagnosis. The 4T score is validated to calculate the pretest probability of HIT in patients with thrombocytopenia. A high burden of HIT testing in patients with a low 4T score was noticed in our hospital system. Objectives The primary objectives of this study were to: (1) quantify the burden of anti- PF4 ELISA testing ordered in patients with a low pretest probability in our system, and (2) assess for reduction in such testing and assess for improvements in ordering patterns after introducing a 4T score calculation in the EMR. Methods We conducted a quality improvement project to assess the reduction in anti- PF4 ELISA testing in patients with pretest probability of HIT. As a first phase of our study, we incorporated changes into the electronic medical record (EMR) and compared HIT testing 3 months before and after the intervention. Results Our intervention resulted in a significant increase in the calculation of the 4T score by the primary teams (13/75 vs. 25/58, p =0.001) as well as the consultation a significant increase in the consultation with the hematology team (10/75 vs. 23/58, p <0.001) when suspecting HIT. We also noted a significant reduction in HIT testing in patients with a low 4T score (51/75 vs. 28/58, p = 0.022). Conclusions EMR based interventions were modestly successful in reducing inappropriate HIT testing in our hospital system and can be easily mirrored in other institutions. They likely need to be supplemented by additional interventions such as physician education, auditing of anti PF4 ELISA testing, and/ or oversight by anticoagulation stewardship teams. We will be creating targeted educational modules to consolidate the success of the current intervention.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.