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

William L. Galanter, Mathew Thambi, Holly Rosencranz, Bobby Shah, Suzanne Falck, Fang Ju Lin, Edith Nutescu*, Bruce Lambert

*Corresponding author for this work

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

Purpose. The implementation of a mandatory assessment of risk for venous thromboembolism (VTE) in a health system's electronic medical record (EMR) and clinical decision-support (CDS) system was evaluated to measure its effect on the use of pharmacologic prophylaxis and the occurrence of VTE and bleeding events. Methods. A commercially available CDS system was used in designing the automated CDS intervention. During computerized order entry, the system delivered alerts prompting clinician risk assessment and also delivered alerts under circumstances suggesting less-than-optimal prophylaxis. Rates of pharmacologic prophylaxis, clinically diagnosed hospital-acquired VTE, and hospital-acquired bleeding events were measured during one year before and one year after implementation. Results. After adjustment for patient age, sex, and high-risk comorbidities, the data showed a postimplementation increase in the percentage of patients who received pharmacologic prophylaxis at some time during their admission from 25.9% to 36.8% (p < 0.001). The rate of VTE for the entire hospital did not change significantly, but a significant reduction among patients on medical units was observed, from 0.55% to 0.33% (p = 0.02). There was no increase in either major or minor bleeding events. Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)1265-1273
Number of pages9
JournalAmerican Journal of Health-System Pharmacy
Volume67
Issue number15
DOIs
StatePublished - Aug 1 2010

Keywords

  • Anticoagulants
  • Computers
  • Decision making
  • Hemorrhage
  • Hospitals
  • Medication orders
  • Protocols
  • Records
  • Risk management
  • Toxicity
  • Venous thromboembolism

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

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