May Jori E, Hearld Kristine R, Ogunsile Foluso Joy, Kennamer Gretchen A, Mitchell Kesley, Taylor Laura J, Marques Marisa B
Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Res Pract Thromb Haemost. 2024 Jul 31;8(5):102537. doi: 10.1016/j.rpth.2024.102537. eCollection 2024 Jul.
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.
To increase the delivery of evidence-based care of patients with suspected and confirmed HIT via electronic consultation (e-consult).
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.
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.
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.
肝素诱导的血小板减少症（HIT）是肝素暴露的一种并发症，与发病和死亡的高风险相关。由于实验室检测的局限性以及对非肝素抗凝的需求，诊断和管理较为复杂。
通过电子会诊（e-consult）增加对疑似和确诊HIT患者的循证护理。
我们描述了在一家大型学术医疗中心为关注HIT的患者创建和实施电子会诊服务的过程。具有HIT专业知识的血液科医生对所有筛查免疫测定结果呈阳性的患者进行实时病历审查，并在其电子健康记录中提供书面建议。
比较电子会诊服务实施前一年和实施后一年的结果，发现直接凝血酶抑制剂管理得到改善，诊断准确性提高，确诊HIT患者的住院时间缩短。
电子会诊平台是一种快速、有针对性的咨询指导新方法，这项单机构试点证明了其改善疑似和确诊HIT患者护理的可行性和有效性。
