Effects of Computerised Clinical Decision Support on Adherence to VTE Prophylaxis Clinical Practice Guidelines among Hospitalised Patients

Abstract

Objective Venous thromboembolism (VTE) is an important patient safety concern. VTE leads to significant mortality and morbidity and a burden on healthcare resources. Despite the widespread availability of evidence-based clinical practice guidelines on VTE prophylaxis, we found that only 50.9% of our patients were receiving appropriate prophylaxis. The purpose of this study was to evaluate the impact of automation of an adapted VTE prophylaxis CPG using a clinical decision support system (the VTE–CDSS) on VTE prevention among hospitalised adult patients. Design and setting A quasi-experimental study (pre- and post-implementation) was conducted at a large 900-bed tertiary teaching multi-specialty hospital in Riyadh, Saudi Arabia. Participants The 1809 adult patients in the study included 871 enrolled during the pre-implementation stage and 938 enrolled during the post-implementation stage. Intervention Multi-faceted implementation interventions were utilised, including leadership engagement and support, quality and clinical champions, staff training and education and regular audit and feedback. Main outcome measure Two rate-based process measures were calculated for each admission cohort (i.e. pre- and post-implementation): the percentage of inpatients who were assessed for VTE risk on admission and the percentage of inpatients who received appropriate VTE prophylaxis. Two outcome measures were calculated: the prevalence of hospital-acquired VTE (HA-VTE) events and the in-hospital all-cause mortality. Results The percentage of inpatients risk assessed for VTE on admission increased from 77.4% to 93.3% (P < 0.01). The percentage of patients who received appropriate VTE prophylaxis increased from 50.9% to 81.4% (P < 0.01). The HA-VTE events decreased by 50% from 0.33% to 0.15% (P < 0.01).All-cause in-hospital mortality did not significantly change after implementation of the VTE-CDSS compared with pre-implementation mortality (P > 0.05). Conclusion The VTE-CDSS improved patient safety by enhancing adherence to the VTE prophylaxis best practice and adapted CPG. The multi-faceted implementation strategies approach improved the compliance rate of risk assessment and the adherence to prophylaxis recommendations and substantially reduced the HA-VTE prevalence. A successful CDSS requires a set of critical components to ensure better user compliance and positive patient outcomes.

Electronic health record risk-stratification tool reduces venous thromboembolism events in surgical patients

“…The addition of decision support tools to initiate chemoprophylaxis has aided in increasing chemoprophylaxis and reducing VTE events [ [18] , [19] , [20] , [21] , [22] , [23] , [24] ]. Johns Hopkins Hospitals' implementation of paper and then computerized physician decision support tools increased chemoprophylaxis nearly 3-fold from 2005 to 2011 for surgical patients (26% vs 80.2%) [ 23 , 26 ].…”

“…There has been increasing use of risk assessment models to aid in identification and stratification of at-risk patients [ 17 ]. Additionally, the use of electronic clinical decision-making tools has evolved as a promising modality in standardizing and improving appropriate prophylaxis and reduction of VTE events [ 15 , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ].…”

Translating Guidelines Into Practice: Improving Continuous Glucose Monitoring Device Validation for Patients Using Insulin Pumps During Hospitalization

“…11 Evidence shows that CDS embedded within the EHR that provides actionable information can improve nursing process outcomes. [12][13][14][15][16] Thus, a redesign of the nursing documentation for CGM validation was undertaken.…”

VTE Prophylaxis Therapy: Clinical Practice vs Clinical Guidelines

“…Furthermore, some institutions have implemented a clinical decision support system for VTE prophylaxis prevention assessment during hospitalization to increase health care providers’ adherence to clinical guidelines. 11 Appropriate therapy selection is based on a thorough patient assessment and risk stratification using multiple risk factors for either coagulation or bleeding. For example, the American College of Chest Physicians (ACCP) recommends the Padua and IMPROVE bleeding scores to guide decision-making.…”