Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program

Novis, Sarah J.; Havelka, George E.; Ostrowski, Denise; Levin, Betsy; Blum-Eisa, Laurie; Prystowsky, Jay B.; Kibbe, Melina R.

doi:10.1016/j.jvs.2009.08.097

Cited by 32 publications

(33 citation statements)

References 19 publications

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“…Several recent studies have shown significant reduction in VTE rates as a result of increasing prophylaxis utilization through implementing new protocols and guidelines. [16][17][18] As obesity is still associated with worsening overall postoperative morbidity, 19,20 this supports our hypothesis that DVT rates are similar as a result of increased VTE prophylaxis.…”

Section: Commentssupporting

confidence: 62%

Perioperative rates of deep vein thrombosis and pulmonary embolism in normal weight vs obese and morbidly obese surgical patients in the era post venous thromboembolism prophylaxis guidelines

Wang

Pryor

Altieri

et al. 2015

The American Journal of Surgery

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Section: Commentssupporting

confidence: 62%

Perioperative rates of deep vein thrombosis and pulmonary embolism in normal weight vs obese and morbidly obese surgical patients in the era post venous thromboembolism prophylaxis guidelines

Wang

Pryor

Altieri

et al. 2015

The American Journal of Surgery

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“…Second, we were able to create our order set within a commercial EHR used by more than 300 academic and community healthcare institutions in and outside the U.S.; thus, our intervention can be utilized by many other institutions either using the same or a similar EHR. Third, we were able to reach all hospitalized populations across multiple hospitals in an academic health care system, instead of select populations [8,11,12] or a single hospital [17] as investigated in many other studies.…”

Section: Discussionmentioning

confidence: 99%

“…Many methods to improve VTE prophylaxis in the hospital setting have been studied, including the use of computerized clinical decision support (CDS) interventions [6]. However, many of the CDS interventions studied were limited in that they either used noncommercial homegrown electronic health records (EHR) [7-13], pop-up alerts to remind providers when patients with VTE risk factors were not on prophylaxis [7-11,13-16], or targeted select populations [8,11,12] or individual hospitals [17]. These limitations could impact the generalizability of the studies’ findings across multi-hospital systems, particularly given the ubiquitous nature of pop-up alerts and the associated alert fatigue [18], challenges associated with translating the functionality of a homegrown EHR into a commercial one, and obstacles associated with implementing change across multiple institutions.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a novel and scalable clinical decision support intervention to improve venous thromboembolism prophylaxis: a quasi-experimental study

Umscheid

Hanish

Chittams

et al. 2012

BMC Med Inform Decis Mak

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BackgroundVenous thromboembolism (VTE) causes morbidity and mortality in hospitalized patients, and regulators and payors are encouraging the use of systems to prevent them. Here, we examine the effect of a computerized clinical decision support (CDS) intervention implemented across a multi-hospital academic health system on VTE prophylaxis and events.MethodsThe study included 223,062 inpatients admitted between April 2007 and May 2010, and used administrative and clinical data. The intervention was integrated into a commercial electronic health record (EHR) in an admission orderset used for all admissions. Three time periods were examined: baseline (period 1), and the time after implementation of the first CDS intervention (period 2) and a second iteration (period 3). Providers were prompted to accept or decline prophylaxis based on patient risk. Time series analyses examined the impact of the intervention on VTE prophylaxis during time periods two and three compared to baseline, and a simple pre-post design examined impact on VTE events and bleeds secondary to anticoagulation. VTE prophylaxis and events were also examined in a prespecified surgical subset of our population meeting the public reporting criteria defined by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI).ResultsUnadjusted analyses suggested that “recommended”, “any”, and “pharmacologic” prophylaxis increased from baseline to the last study period (27.1% to 51.9%, 56.7% to 78.1%, and 42.0% to 54.4% respectively; p < 0.01 for all comparisons). Results were significant across all hospitals and the health system overall. Interrupted time series analyses suggested that our intervention increased the use of “recommended” and “any” prophylaxis by 7.9% and 9.6% respectively from baseline to time period 2 (p < 0.01 for both comparisons); and 6.6% and 9.6% respectively from baseline to the combined time periods 2 and 3 (p < 0.01 for both comparisons). There were no significant changes in “pharmacologic” prophylaxis in the adjusted model. The overall percent of patients with VTE increased from baseline to the last study period (2.0% to 2.2%; p = 0.03), but an analysis excluding patients with VTE “present on admission” (POA) demonstrated no difference in events (1.3% to 1.3%; p = 0.80). Overall bleeds did not significantly change. An analysis examining VTE prophylaxis and events in a surgical subset of patients defined by the AHRQ PSI demonstrated increased “recommended”, “any”, and “pharmacologic” prophylaxis from baseline to the last study period (32.3% to 60.0%, 62.8% to 85.7%, and 47.9% to 63.3% respectively; p < 0.01 for all comparisons) as well as reduced VTE events (2.2% to 1.7%; p < 0.01).ConclusionsThe CDS intervention was associated with an increase in “recommended” and “any” VTE prophylaxis across the multi-hospital academic health system. The intervention was also associated with increased VTE rates in the overall study population, but a subanalysis using only admissions with appropriate POA documentation sugge...

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“…There are data supporting the utilization of clinical decision support tools (CDST) within the EHR and their impact on VTE prophylaxis compliance. [5][6][7] Haut and colleagues conducted a study to examine documentation and compliance to guidelines in a trauma population before and after a mandatory risk factor stratification tool and orderset. 6 They found that both documentation and compliance increased following implementation (3% vs 97.8% and 66.2% vs 84.4%, respectively; P < .001).…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism Prophylaxis Compliance before and after Electronic Health Record Implementation

Saum

Reeves

2016

Hosp Pharm

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Background Adherence to American College of Chest Physicians (CHEST) and National Comprehensive Cancer Network (NCCN) guidelines for venous thromboembolism (VTE) prophylaxis helps avoid thromboembolic complications during hospitalization. Electronic health records (EHR) have the potential to make an impact on guideline adherence, but data are lacking. Objectives To determine compliance with VTE prophylaxis guidelines in internal medicine and oncology populations and to determine whether EHR implementation had any effect on the rate and appropriateness of prophylaxis practices. Methods A retrospective chart review was conducted on medical and oncology patients admitted to the hospital for a 2-month period pre-EHR and post-EHR implementation. Risk assessment tools were available pre and post, however they were not mandatory. The rate of VTE prophylaxis was compared between the 2 time periods, with appropriateness assessed in a subgroup of participants without prophylaxis. Results A total of 2,423 patients on the oncology and internal medicine floors were identified during the pre-EHR ( n = 1,171) and post-EHR ( n = 1,252) time periods. Patients in the post-EHR group were less likely to be prescribed prophylaxis as compared to those in the pre-EHR group (43% vs 50%; P = .001). In the patients audited for proper prophylaxis use ( n = 750), significantly more patients in the post-EHR group had risk factors (84% vs 53%; P <.001) and contraindications (23% vs 8%; P = .001) than in the pre-EHR group. Noncompliance to prophylaxis in patients who were candidates (positive risk factors without contraindications) occurred more often in the post-EHR group (51% vs 39%; P <.001). Conclusion Implementation of an EHR was associated with an increase in the documentation of risk factors and contraindications; however, there was a significant decrease in VTE prophylaxis utilization after EHR implementation.

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Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program

Abstract: The creation and implementation of a standardized DVT risk assessment program in the electronic medical record significantly increased use of pharmacological and mechanical DVT prophylaxis before surgery in a Veterans Affairs Medical Center setting.

Cited by 32 publications

References 19 publications

Perioperative rates of deep vein thrombosis and pulmonary embolism in normal weight vs obese and morbidly obese surgical patients in the era post venous thromboembolism prophylaxis guidelines

Perioperative rates of deep vein thrombosis and pulmonary embolism in normal weight vs obese and morbidly obese surgical patients in the era post venous thromboembolism prophylaxis guidelines

Effectiveness of a novel and scalable clinical decision support intervention to improve venous thromboembolism prophylaxis: a quasi-experimental study

Venous Thromboembolism Prophylaxis Compliance before and after Electronic Health Record Implementation

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