Effects of clinical decision support on venous thromboembolism risk assessment, prophylaxis, and prevention at a university teaching hospital

Abstract

Without increasing the risk of bleeding, a CDS system requiring clinicians to document VTE risk assessment in the EMR promoted improved rates of pharmacologic prophylaxis at any time during an admission and a decreased risk of VTE in general medical patients but not all adult patients.

Systematic review of clinical decision support interventions with potential for inpatient cost reduction

“…A majority (52.6%) of studies were published during or after 2008 [14,15,18-20,25,26,29,32-34,38-40],[43-47,49,50,55-61,65-67,70,74-76,78],[81,82,85,86,90]. The earliest included study was published in 1989 [54].…”

“…A majority of the studies (55.1%) took place in a general hospital setting ([14-17,19,24-26,28,30,32,33,37],[41-43,46,48-50,52-56,60-62,64,66,67],[69-72,74,76-78,80,85,87,90]. 29.5% of the studies occurred in an ICU setting [18,23,31,34-36,39,40,44,47],[51,57-59,63,65,68,73,79,82],[86,88,89], and 15.4% took place in an ED setting [13,20-22,27,29,38,45,75,81],[83,84].…”

“…The most common clinical focus targeted by CDS systems in the review was pharmacotherapy, with 53.8% of studies focused on this area [16-18,20,23,24,26,35,37,39],[40,42,43,45,47,48,50,51],[54,57-62,64,65,67-69,71-74,76-79,85],[88-90]. Of the studies focused on pharmacotherapy, the most common areas of specific focus were nephrotoxic drugs (23.8%) [24,41,60,69,76-78,85,90], antibiotics (21.4%) [20,23,26,35,54,62,68,71],[88], and insulin management (14.3%) [39,40,57,59,65,79].…”

ASHP Therapeutic Position Statement on the Role of Pharmacotherapy in Preventing Venous Thromboembolism in Hospitalized Patients

“…39,[98][99][100][101][102] The implementation of one such program led to a significant increase in appropriate type, dose, and duration of prophylaxis while also significantly reducing "preventable" VTE events (relative risk reduction = 74%, p = 0.0006). 39 Another pharmacistdriven program significantly increased optimal VTE prophylaxis among hospitalized nonsurgical patients from 11% to 44% (p < 0.001).…”

Risk Stratification and Prophylaxis of Venous Thromboembolic Events in Obstetrics

“…With regard to the risks and benefits of VTE prophylaxis, one may need to consider the possible bleeding consequences of pharmacologic prophylaxis, [5][6][7][8] as well as the sometimes limited effectiveness or compliance of using the mechanical modality of Sequential Compression Devices (SCDs) [9]. The potential impact of any standardized use of a VTE prophylaxis measure in obstetric/gynecologic practice needs to be considered [10][11][12]. Specifically for cesarean deliveries, we may need to emphasize VTE pharmacologic prophylaxis for particular risk factors.…”