title: Use of a computer-based provider order entry (CPOE) intervention to optimize laboratory testing in patients with suspected heparin-induced thrombocytopenia.
abstract: BACKGROUND
  Heparin-induced thrombocytopenia (HIT) is a rare but frequently considered diagnosis in hospitalized patients. Despite the availability of clinical prediction tools, HIT is often over-diagnosed and patients can be subjected to unnecessary and expensive testing.
  
  
  METHODS
  A decision-support tool requiring providers to calculate the 4Ts (HIT risk) score prior to ordering laboratory-based tests for anti-PF4/heparin antibody enzyme-linked immunosorbent assay (ELISA) testing was implemented at our institution in January 2014. Charts of adult patients who underwent ELISA or serotonin release assay (SRA) testing during the 8-month time periods prior to and following this intervention were reviewed and 4Ts scores at the time of ELISA or SRA testing were calculated.
  
  
  RESULTS
  A total of 443 ELISA and SRA tests were sent for 411 patients during the time periods studied. We observed a significant decrease from 43 tests/month before to 22 tests/month (p < 0.001) after the intervention. A total of 337 charts were reviewed. We observed a trend toward decrease in the proportion of tested patients with low 4Ts scores (66% vs 56%, p = 0.069), as well as an increase in the average 4Ts score of tested patients (3.0 vs 3.4, p = 0.010) following our intervention.
  
  
  CONCLUSIONS
  Over-testing and treatment for HIT are frequent and potentially harmful occurrences in hospitalized patients. Our study demonstrates that a clinical decision support tool embedded within the electronic ordering process can decrease unnecessary testing for HIT.
authors.affiliation: Department of Medicine, Division of Hematology, University of Washington, United States. Electronic address: bts99@uw.edu.
authors.forename: Bethany T
authors.initials: BT
authors.lastname: Samuelson
authors.affiliation: Department of Laboratory Medicine, University of Washington, United States.
authors.forename: Emily
authors.initials: E
authors.lastname: Glynn
authors.affiliation: Department of Pharmacy, University of Washington, United States.
authors.forename: Meredith
authors.initials: M
authors.lastname: Holmes
authors.affiliation: Department of Medicine, Division of General Internal Medicine University of Washington, United States.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: White
authors.affiliation: Department of Medicine, Division of Hematology, University of Washington, United States.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Martin
authors.affiliation: Department of Medicine, Division of Hematology, University of Washington, United States.
authors.forename: David
authors.initials: D
authors.lastname: Garcia
mesh_terms: D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D007753:Laboratories / Q000592:standards*; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D013921:Thrombocytopenia / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D006493:Heparin
keywords: 4Ts score; Computer-based provider order entry; Heparin-induced thrombocytopenia; Inappropriate testing