J Am Med Inform Assoc - The impact of the heparin-induced thrombocytopenia (HIT) computerized alert on provider behaviors and patient outcomes.

Tópicos

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Resumo

JECTIVE: The aim of this study was to measure the effect of an electronic heparin-induced thrombocytopenia (HIT) alert on provider ordering behaviors and on patient outcomes.MATERIALS AND METHODS: A pop-up alert was created for providers when an individual's platelet values had decreased by 50% or to <100,000/mm(3) in the setting of recent heparin exposure. The authors retrospectively compared inpatients admitted between January 24, 2008 and August 24, 2008 to a control group admitted 1 year prior to the HIT alert. The primary outcome was a change in HIT antibody testing. Secondary outcomes included an assessment of incidence of HIT antibody positivity, percentage of patients started on a direct thrombin inhibitor (DTI), length of stay and overall mortality.RESULTS: There were 1006 and 1081 patients in the control and intervention groups, respectively. There was a 33% relative increase in HIT antibody test orders (p=0.01), and 33% more of these tests were ordered the first day after the criteria were met when a pop-up alert was given (p=0.03). Heparin was discontinued in 25% more patients in the alerted group (p=0.01), and more direct thrombin inhibitors were ordered for them (p=0.03). The number who tested HIT antibody-positive did not differ, however, between the two groups (p=0.99). The length of stay and mortality were similar in both groups.CONCLUSIONS: The HIT alert significantly impacted provider behaviors. However, the alert did not result in more cases of HIT being detected or an improvement in overall mortality. Our findings do not support implementation of a computerized HIT alert.

Resumo Limpo

jectiv aim studi measur effect electron heparininduc thrombocytopenia hit alert provid order behavior patient outcomesmateri method popup alert creat provid individu platelet valu decreas mm set recent heparin exposur author retrospect compar inpati admit januari august control group admit year prior hit alert primari outcom chang hit antibodi test secondari outcom includ assess incid hit antibodi posit percentag patient start direct thrombin inhibitor dti length stay overal mortalityresult patient control intervent group respect relat increas hit antibodi test order p test order first day criteria met popup alert given p heparin discontinu patient alert group p direct thrombin inhibitor order p number test hit antibodyposit differ howev two group p length stay mortal similar groupsconclus hit alert signific impact provid behavior howev alert result case hit detect improv overal mortal find support implement computer hit alert

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