Journal of Thrombosis and Thrombolysis

, Volume 28, Issue 2, pp 124–131

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

  • Jeffrey M. Riggio
  • Mandelin K. Cooper
  • Benjamin E. Leiby
  • Jeanine M. Walenga
  • Geno J. Merli
  • Jonathan E. Gottlieb
Article

DOI: 10.1007/s11239-008-0279-x

Cite this article as:
Riggio, J.M., Cooper, M.K., Leiby, B.E. et al. J Thromb Thrombolysis (2009) 28: 124. doi:10.1007/s11239-008-0279-x

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.

Keywords

Heparin induced thrombocytopeniaClinical decision support systemComputer alertComputerized provider order entry

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Jeffrey M. Riggio
    • 1
  • Mandelin K. Cooper
    • 2
  • Benjamin E. Leiby
    • 3
  • Jeanine M. Walenga
    • 4
  • Geno J. Merli
    • 5
  • Jonathan E. Gottlieb
    • 6
  1. 1.Department of Medicine, Jefferson Internal Medicine AssociatesThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Department of PharmacyWesley Medical CenterWichitaUSA
  3. 3.Division of Biostatistics, Department of Pharmacology and Experimental TherapeuticsThomas Jefferson UniversityPhiladelphiaUSA
  4. 4.Department of Thoracic and Cardiovascular Surgery and Pathology, Cardiovascular InstituteLoyola University Medical CenterMaywoodUSA
  5. 5.Department of Medicine, Jefferson Center for Vascular DiseasesThomas Jefferson UniversityPhiladelphiaUSA
  6. 6.Department of Medicine, Barnes-Jewish HospitalWashington University School of MedicineSt. LouisUSA