Improving hospital venous thromboembolism prophylaxis with electronic decision support

Rohit Bhalla, Matthew Alan Berger, Stan H. Reissman, Brandon G. Yongue, Jason S. Adelman, Laurie G. Jacobs, Henny H. Billett, Mark J. Sinnett, Gary Kalkut

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)115-120
Number of pages6
JournalJournal of Hospital Medicine
Volume8
Issue number3
DOIs
StatePublished - Mar 2013

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Venous Thromboembolism
Medicine
Safety
Inpatients
Thrombocytopenia
Hemorrhage
Hospital Medicine
Incidence
Quality Improvement
Information Systems
Observational Studies
Cohort Studies

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

Cite this

Improving hospital venous thromboembolism prophylaxis with electronic decision support. / Bhalla, Rohit; Berger, Matthew Alan; Reissman, Stan H.; Yongue, Brandon G.; Adelman, Jason S.; Jacobs, Laurie G.; Billett, Henny H.; Sinnett, Mark J.; Kalkut, Gary.

In: Journal of Hospital Medicine, Vol. 8, No. 3, 03.2013, p. 115-120.

Research output: Contribution to journalArticle

Bhalla, Rohit ; Berger, Matthew Alan ; Reissman, Stan H. ; Yongue, Brandon G. ; Adelman, Jason S. ; Jacobs, Laurie G. ; Billett, Henny H. ; Sinnett, Mark J. ; Kalkut, Gary. / Improving hospital venous thromboembolism prophylaxis with electronic decision support. In: Journal of Hospital Medicine. 2013 ; Vol. 8, No. 3. pp. 115-120.
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abstract = "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.",
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AU - Jacobs, Laurie G.

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AB - 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.

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