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

Essentials•Heparin-induced thrombocytopenia (HIT) is life-threatening and complex to diagnose and treat.•We developed an electronic consultation (e-consult) service for patients with positive HIT testing results.•In patients with suspected HIT, e-consult decreased unnecessary use of bivalirudin.•In patients with confirmed HIT, e-consult decreased the mean length of hospitalization.AbstractBackgroundHeparin-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.ObjectivesTo increase the delivery of evidence-based care of patients with suspected and confirmed HIT via electronic consultation (e-consult).MethodsWe 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.ResultsComparison 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.ConclusionThe 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.