Reducing Inappropriate Simultaneous Ordering of Heparin Antibody and Serotonin Release Assays

Joseph Talledo, Hyung J. Cho, Daniel Alaiev, Sigal Israilov, Komal Chandra, Milana Zaurova, Peter Alacron Manchego, Dawi Shin, Surafel Tsega, Mona Krouss

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: A 4T score with intermediate or high probability of heparin-induced thrombocytopenia prompts ordering of anti-platelet 4 heparin complex. If positive, a serotonin release assay (SRA) is recommended to confirm diagnosis. Despite these recommendations, overtesting of both anti-platelet 4 and SRA is highly prevalent. Methods: This was a quality improvement initiative using two forms of clinical decision support across 11 acute care hospitals. First, a 4T calculator was incorporated into anti-platelet 4 orders. Second, a Best Practice Advisory fired when anti-platelet 4 and SRA were ordered simultaneously, prompting the provider to remove the SRA order. Data were analyzed by a quasi-experimental interrupted time series linear regression comparing weekly average laboratory tests per 1,000 patient-days pre- and postintervention. Results: Average ordering frequency of anti-platelet 4 changed from 0.508 to 0.510 per 1,000 patient-days (0.5%, p = 0.42) without significant slope or level differences. Average ordering frequency of SRA decreased from 0.430 to 0.289 per 1,000 patient-days (32.8%, p < 0.001) with a significant level difference of -0.128 orders per 1,000 patient-days (-31.2%, p < 0.05). Conclusion: A simultaneous Best Practice Advisory was effective in reducing SRA orders, but not anti-platelet 4 orders.

Original languageEnglish
Pages (from-to)306-312
Number of pages7
JournalJoint Commission Journal on Quality and Patient Safety
Issue number6-7
StatePublished - 1 Jun 2023


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