Electronic consultation to improve care outcomes in patients with suspected and confirmed heparin-induced thrombocytopenia

Jori E May; Kristine R Hearld; Foluso Joy Ogunsile; Gretchen A Kennamer; Kesley Mitchell; Laura J Taylor; Marisa B Marques

doi:10.1016/j.rpth.2024.102537

Electronic consultation to improve care outcomes in patients with suspected and confirmed heparin-induced thrombocytopenia

Res Pract Thromb Haemost. 2024 Jul 31;8(5):102537. doi: 10.1016/j.rpth.2024.102537. eCollection 2024 Jul.

Authors

Jori E May¹, Kristine R Hearld², Foluso Joy Ogunsile¹, Gretchen A Kennamer³, Kesley Mitchell³, Laura J Taylor⁴, Marisa B Marques⁵

Affiliations

¹ Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
² Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA.
³ Department of Clinical Informatics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁴ Division of Laboratory Medicine, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁵ Special Coagulation Service, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Abstract

Background: Heparin-induced thrombocytopenia (HIT) is a complication of heparin exposure associated with high risk for morbidity and mortality. Diagnosis and management are complex due to limitations of laboratory testing and the need for nonheparin anticoagulation.

Objectives: To increase the delivery of evidence-based care of patients with suspected and confirmed HIT via electronic consultation (e-consult).

Methods: We describe the creation and implementation of an e-consult service for patients with concern for HIT at a large academic medical center. Hematology physicians with HIT expertise performed real-time chart review of all patients with a positive screening immunoassay result and provided written recommendations in their electronic health record.

Results: Comparison of outcomes for 1 year before and the year after the e-consult service implementation identified improvements in direct thrombin inhibitor stewardship, increased diagnostic accuracy, and decreased length of stay of patients with confirmed HIT.

Conclusion: The e-consult platform is a novel method for rapid, targeted consultative guidance, and this single-institution pilot demonstrates its feasibility and effectiveness to improve the care of patients with suspected and confirmed HIT.

Keywords: heparin; quality improvement; referral and consultation; remote consultation; thrombocytopenia; thrombosis.