Improving Hospital Venous Thromboembolism Prophylaxis with Electronic Decision Support
This is a review of the 2013 article by Bhalla et al. 
BACKGROUND Venous thromboembolism (VTE) disease prophylaxis rates among medical inpatients have been noted to be <50%.
OBJECTIVE Our objective was to evaluate the effectiveness and safety of a computerized decision support application to improve VTE prophylaxis.
DESIGN Observational cohort study.
SETTING Academic medical center.
PATIENTS Adult inpatients on hospital medicine and nonmedicine services.
INTERVENTION A decision support application designed by a quality improvement team was implemented on medicine services in September 2009.
MEASUREMENTS Effectiveness and safety parameters were compared on medicine services and nonmedicine (nonimplementation) services for 6-month periods before and after implementation. Effectiveness was evaluated by retrospective information system queries for rates of any VTE prophylaxis, pharmacologic VTE prophylaxis, and hospital-acquired VTE incidence. Safety was evaluated by queries for bleeding and thrombocytopenia rates.
RESULTS Medicine service overall VTE prophylaxis increased from 61.9% to 82.1% (P < 0.001), and pharmacologic VTE prophylaxis increased from 59.0% to 74.5% (P < 0.001). Smaller but significant increases were observed on nonmedicine services. Hospital-acquired VTE incidence on medicine services decreased significantly from 0.65% to 0.42% (P = 0.008) and nonsignificantly on nonmedicine services. Bleeding rates increased from 2.9% to 4.0% (P < 0.001) on medicine services and from 7.7% to 8.6% (P = 0.043) on nonmedicine services, with nonsignificant changes in thrombocytopenia rates observed on both services.
CONCLUSIONS An electronic decision support application on inpatient medicine services can significantly improve VTE prophylaxis and hospital-acquired VTE rates with a reasonable safety profile.
Complications of venous thromboembolism are a major source of morbidity in hospital inpatients. Methods of prevention are well described, but underutilized. The authors seek to evaluate the impact of a CDS system in encouraging proper VTE prophylaxis ordering, and enhancing quality of healthcare delivery
The authors tracked inpatients at a large academic center. VTE prophylaxis ordering, and VTE events were tracked over separate 6 months periods prior to, and after implementation of the system
Comparing the periods prior to and after CDS implementation, there were significant increases in overall VTE prophylaxis utilization on the medicine service, from 62% to 82%. On the medicine service, incidence of VTE dropped from 0.65% to 0.42% after implementation, this was statistically significant. Bleeding events, a potential complication of prophylaxis, increased from 2.9% to 4.1% on the medicince service.
Use of a CDS system increased compliance with VTE prophylaxis in this large academic center. VTE events were decreased after implementation of the system, and bleeding events were slightly increased, an expected finding with increased utilization of blood thinners.
VTE is one of the most common, and most preventable sources of morbidity and death in the hospital setting. Utilization of CDS to maximize prevention strategies has the potential to make a massive impact in patient safety and should be aggressively implemented.
- Bhalla, R., Berger, M. A., Reissman, S. H., Yongue, B. G., Adelman, J. S., Jacobs, L. G., … Kalkut, G. (2013). Improving hospital venous thromboembolism prophylaxis with electronic decision support. Journal of Hospital Medicine, 8(3), 115–120. http://doi.org/10.1002/jhm.1993