Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, 39 Sabin Street, MSC 635, Charleston, SC, 29425, USA.
Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA.
J Thromb Thrombolysis. 2018 Jan;45(1):130-134. doi: 10.1007/s11239-017-1592-z.
Many medical centers are faced with a major challenge in making an accurate diagnosis of heparin-induced thrombocytopenia (HIT) and ensuring appropriate changes in management strategy in line with guideline recommendations. We report the initial and long-term impact and challenges of institution-wide changes in the diagnosis and management of HIT in the inpatient setting at an academic medical center. We established a HIT Task Force, consisting of a multidisciplinary team of non-malignant hematologists, nursing, pharmacist, pathology, blood bank and clinical lab informatics. Changes were implemented from 2011 to 2012. In 2013, testing for PF4 and SRA decreased by 37.5 and 85%, respectively. 100% of positive PF4 received an automatic hematology consult to guide management, leading to a 78% reduction in the use of direct thrombin inhibitors. Annual audits in the subsequent years demonstrated increasing testing for HIT due to changes in the electronic ordering system. Through continuous monitoring, these shortfalls were detected and intervene early on with continued success. The implementation of a centralized hospital-wide protocol via a multidisciplinary task force that coordinates testing and treatment of patients suspected of having HIT led to a substantial reduction in PF4 and SRA testing, as well as use of DTIs, resulting in a safe and cost-effective approach for the diagnosis and treatment of HIT. Our study highlights the important of continuous monitoring to maintain the improvements made. Despite our initial success, annual re-auditing allowed for early detection of challenges, which then allowed appropriate early intervention.
许多医疗中心在准确诊断肝素诱导的血小板减少症（HIT）并确保根据指南建议改变管理策略方面面临重大挑战。我们报告了在学术医疗中心住院环境中，通过在全机构范围内改变 HIT 的诊断和管理，最初和长期的影响和挑战。我们成立了一个 HIT 工作组，由非恶性血液病、护理、药剂师、病理学、血库和临床实验室信息学的多学科团队组成。从 2011 年到 2012 年实施了这些改变。2013 年，PF4 和 SRA 的检测量分别减少了 37.5%和 85%。100%的 PF4 阳性患者都收到了自动血液学咨询，以指导管理，导致直接凝血酶抑制剂的使用减少了 78%。随后几年的年度审计表明，由于电子医嘱系统的改变，HIT 的检测量有所增加。通过持续监测，这些缺陷被发现并及早进行干预，取得了持续的成功。通过多学科工作组实施集中式全院协议，协调对疑似 HIT 患者的检测和治疗，导致 PF4 和 SRA 检测以及直接凝血酶抑制剂的使用大幅减少，为 HIT 的诊断和治疗提供了安全且具有成本效益的方法。我们的研究强调了持续监测以保持改进的重要性。尽管我们最初取得了成功，但年度复查允许早期发现挑战，从而允许进行适当的早期干预。
