Heparin-induced thrombocytopenia (HIT) testing at an urban teaching hospital: choosing wisely
Project Description: UF Health Jacksonville is a 603-bed urban teaching hospital serving northeast Florida and southeast Georgia. On admission, physicians routinely assess patients for deep venous thrombo-embolism (VTE) risk and medical inpatients are almost universally assigned to receive prophylactic subcutaneous heparin. A percentage of patients (<5 percent) will develop heparin-induced thrombocytopenia (HIT). The American Society of Hematology Choosing Wisely Guidelines 2014 recommend against testing for HIT in individuals at low risk, defined by a 4T score ≤ 3. The incidence, investigation and management of HIT has never been studied at UF Health Jacksonville, but data from other health systems has shown prevalent overtesting, overdiagnosis and overtreatment making HIT a costly problem. From an operational view, HIT assay is a costly test and it is neither necessary nor cost-effective to perform HIT testing indiscriminately. Optimizing the use of HIT testing has benefits to payers of medical services, clinical and laboratory staff and ultimately the organization (UF Health Jacksonville and the UFCOM-Jacksonville). It also espouses the concept of “high value care” promoted by the American College of Physicians (ACP) for internal medicine physicians.
QPI: Satish, Maharaj, (email@example.com)
Collaborators: Karan, Seegobin, (firstname.lastname@example.org)
Advisors: Marwan, Shaikh, (email@example.com); Jeffrey, House, (firstname.lastname@example.org); Agnes, Aysola, (email@example.com)
UF Health Big Aims: Increase Value None
MeSH Keywords: Cost-Benefit Analysis, Hematology, Inpatients, Thrombosis, Heparin