Economic impact of an electronic alert system to prevent venous thromboembolism in hospitalised patients

Abstract

Summary. Objectives: The prevention of venous thromboembolism (VTE) is a priority for improved safety in hospitalised patients. Worldwide, there is growing concern over the undersuse of appropriate thromboprophylaxis. Computerised decision support improves the implementation of thromboprophylaxis and reduces inpatient VTE. However, an economic assessment of this approach has not yet been performed. Objectives: To evaluate the economic impact of an electronic alert (e-alert) system to prevent VTE in hospitalised patients over a 4 year period. Patients/methods: All hospitalised patients at a single institution during the first semesters of [2005][2006][2007][2008][2009] (n = 32 280) were included. All cases of VTE developed during hospitalisation were followed and direct costs of diagnosis and management collected. Results: E-alerts achieved a sustained reduction of the incidence of in-hospital VTE, OR 0.50 (95% CI, 0.29-0.84), the impact being especially significant in medical patients, OR 0.44 (95% CI, 0.22-0.86). No increase in prophylaxis-related bleeding was observed. In our setting, the mean direct cost (during hospitalisation and after discharge) of an in-hospital VTE episode is €7058. Direct costs per single hospitalised patient were reduced after e-alerts from €21.6 to €11.8, while the increased use of thromboprophylaxis and the development of e-alerts meant €3 and €0.35 per patient, respectively. Thus, the implementation of e-alerts led to a net cost saving of €6.5 per hospitalised patient. Should all hospitalised patients in Spain be considered, total yearly savings would approach €30 million. Conclusions: E-alerts are useful and cost-effective tools for thromboprophylaxis strategy in hospitalised patients. Fewer thromboembolic complications and lower costs are achieved by its implementation.

Electronic Alerts for Triage Protocol Compliance Among Emergency Department Triage Nurses

“…The most appropriate type of alert, however, remains unknown. Several examples of beneficial alerts exist, improving care in patients at risk for contrast induced nephropathy (Cho et al, 2012), decreasing inappropriate cardiac markers (Baron et al, 2012), increasing venous thromboembolism prophylaxis (Lecumberri et al, 2011), and increasing awareness of drug resistant bacteria (Kac et al, 2007). These prior studies, however, utilized “before and after” methodology with limitations inherent to that study design.…”

A review of the empirical evidence of the value of structuring and coding of clinical information within electronic health records for direct patient care

“…Thirteen papers satisfied our inclusion criteria (see Figure 1 for the PRISMA diagram). [17][18][19][20][21][22][23][24][25][26][27][28][29] These papers, 12 from the USA and one from Spain, are summarised in Table 1 and grouped below according to the principal quality dimension for which improvement was evaluated. 14…”

“…The majority of relevant publications focused on improved clinical effectiveness (normally assessed through improved adherence to a clinical guideline). [17][18][19][20][21][22][23][24][25][26] These are subgrouped below by disease area. Two studies introduced a structured format as the only intervention: almost all made use of structured data to present prompts as the influential intervention, or evaluated the use of an EHR system as a whole.…”

“…Lecumberri et al demonstrated that significant costs in the hospital management of venouse thromboembolism (VTE) could be avoided through alerts to prompt clinicians to use prophylaxis in high-risk patients. 20 They studied over 25 000 patients before and after introducing the alert. At-risk patients were identified computationally, according to American College of Chest Physicians' guidelines, through preexisting routinely collected EHR data from medical orders, daily nursing reports, surgery registries and laboratory results.…”

Risk Stratification and Prophylaxis of Venous Thromboembolic Events in Obstetrics

“…For example, one VTE may occur per approximately 1000 pregnancies and per 200 cesarean deliveries during the puerperium [1]. Efforts have been directed towards creating Clinical Decision Support (CDS) tools so as to promote the use of prophylaxis, including pharmacologic and mechanical modalities, in standard clinical practice, possibly resulting in its recent lessened incidence [2,3]. Acknowledgement of the lessons of our clinical data collection can result in the reliance on risk stratification strategies for these continued efforts [4].…”