Maintained effectiveness of an electronic alert system to prevent venous thromboembolism among hospitalized patients

Abstract

SummaryDespite current guidelines, venous thromboembolism( VTE) prophylaxis is underused.Computerized programs to encourage physicians to applythromboprophylaxis have been shownto be effectiveinselectedpopulations. Our aim was to analyzethe impacto ft he implementationo fac omputer-alert system for VTE risk in allhospitalized patients of ateachinghospital. Acomputerprogram linked to the clinical recorddatabase was developed to assess allhospitalized patients'VTE risk daily.Thephysician responsible forp atientsa th igh riskw as alerted,but remainedfreetoorder or withholdprophylaxis.Over19,000 hospitalized, medical and surgical, adult patients between Januaryto Thei mplementationo fac omputer-alert program helps physicians to assess each patient's thrombotic risk,leading to abetter use of thromboprophylaxis, and areductioninthe incidence of VTE among hospitalized patients.For thefirsttime,aninterventionaimed to improveVTE prophylaxis showsmaintained effectivenessovertime.

Venous Thromboembolism in Hospitalized Patients With Heart Failure

“…Importantly, in the randomized and longitudinal observational studies, the electronic alert system was associated with a significant decrease in the incidence of VTE. 79,80 In the absence of a computerized system, preprinted risk stratification scoring systems to identify VTE prophylaxis eligible hospitalized patients and personal or written physician alerts have also been shown to improve VTE prophylaxis rates 85,86 and reduce the incidence of symptomatic VTE. 85 In addition, institution or healthsystem wide education programs using methods such as in-services, institution guideline development, verbal reminders, weekly audits with reporting, and clinical pharmacy led education and monitoring have demonstrated efficacy at improving prophylaxis prescribing.…”

Predicting venous thromboembolism in hospitalized medical patients: are we there yet?

“…Indeed, 80% of the patients included in this study were affected by cancer, a figure that far exceeds the rate encountered in most departments of internal medicine [24]. The risk model proposed by Lecumberri et al was assessed in comparison with historical controls, and recruited patients were not followed-up after discharge [25].…”

“…In order to help stratify the risk for VTE in hospitalized medical patients, several risk assessment models (RAMs) and algorithms have been suggested [19][20][21][22][23][24][25]. However, most of these RAMs have not been prospectively validated, and the only two validated models present limitations that preclude widespread implementation [24,25].…”

“…However, most of these RAMs have not been prospectively validated, and the only two validated models present limitations that preclude widespread implementation [24,25]. The model, proposed by Kucher et al, refers to selected subgroups of medical patients exhibiting a particularly high risk of VTE.…”

“…The adoption of electronic tools was found to be effective in encouraging physicians to use prophylaxis, at least amongst subgroups of patients at high risk of thrombotic complications [24,25]. However, electronic alerting systems require a sophisticated technology infrastructure and considerable financial resources, and are thus unlikely to find widespread acceptance across the many institutions that admit patients at risk of thrombosis.…”