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Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia

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Abstract

Background Subtle decreases in platelet count may impede timely recognition of heparin-induced thrombocytopenia (HIT), placing the patient at increased risk of thrombotic events. Objective A clinical decision support system (CDSS) was developed to alert physicians using computerized provider order entry when a patient with an active order for heparin experienced platelet count decreases consistent with HIT. Methods Comparisons for timeliness of HIT identification and treatment were evaluated for the year preceding and year following implementation of the CDSS in patients with laboratory confirmation of HIT. Results During the intervention time period, the CDSS alert occurred 41,922 times identifying 2,036 patients who had 2,338 inpatient admissions. The CDSS had no significant impact on time from fall in platelet count to HIT laboratory testing (control 2.3 days vs intervention 3.0 days P = 0.30) and therapy (control 19.3 days vs intervention 15.0 days P = 0.45), and appeared to delay discontinuation of heparin products (control 1.3 days vs. intervention 2.9 days P = 0.04). However, discontinuation of heparin following shorter exposure duration and after smaller decrease in platelet count occurred during the intervention period. The HIT CDSS sensitivity and specificity were each 87% with a negative predictive value of 99.9% and positive predictive value of 2.3%. Conclusions Implementation of a CDSS did not appear to improve the ability to detect and respond to potential HIT, but resulted in increased laboratory testing and changes in clinician reactions to decreasing platelet counts that deserve further study.

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Acknowledgment

Special thanks to TJUH Information Systems (Arlene Peters, Renee Brandell-Marino, Mary McNichol, Michael Ekshtut, et al).

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Authors and Affiliations

  1. Department of Medicine, Jefferson Internal Medicine Associates, Thomas Jefferson University, 833 Chestnut Street, Suite 701, Philadelphia, PA, 19107, USA

    Jeffrey M. Riggio

  2. Department of Pharmacy, Wesley Medical Center, 550 N Hillside, Wichita, KS, 67214, USA

    Mandelin K. Cooper

  3. Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut Street, Suite M100, Philadelphia, PA, 19107, USA

    Benjamin E. Leiby

  4. Department of Thoracic and Cardiovascular Surgery and Pathology, Cardiovascular Institute, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, USA

    Jeanine M. Walenga

  5. Department of Medicine, Jefferson Center for Vascular Diseases, Thomas Jefferson University, 111 S. 11th Street, Suite 2210 Gibbon Building, Philadelphia, PA, 19107, USA

    Geno J. Merli

  6. Department of Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, Mailstop 90-91-313, One Barnes-Jewish Hospital Plaza, St. Louis, MO, 63110, USA

    Jonathan E. Gottlieb

Authors
  1. Jeffrey M. Riggio
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  2. Mandelin K. Cooper
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  3. Benjamin E. Leiby
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  4. Jeanine M. Walenga
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  5. Geno J. Merli
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  6. Jonathan E. Gottlieb
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Correspondence to Jeffrey M. Riggio.

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Riggio, J.M., Cooper, M.K., Leiby, B.E. et al. Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia. J Thromb Thrombolysis 28, 124–131 (2009). https://doi.org/10.1007/s11239-008-0279-x

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  • DOI: https://doi.org/10.1007/s11239-008-0279-x

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