The effect of a computerized reminder system on the prevention of postoperative venous thromboembolism.
OBJECTIVE
To measure the effect of an altered process of care, directed by a computerized reminder system, on rates of symptomatic postoperative venous thromboembolism.


METHODS
Comparisons of preintervention and postintervention measurements.


METHODS
A university-affiliated community hospital in Utah.


METHODS
Two-thousand seventy-seven consecutive patients who underwent major operations in four surgical divisions between January 1, 1997, and October 31, 1997 (preintervention), and 2,093 consecutive patients who underwent the same procedures between January 1, 1998, and October 31,1998 (postintervention).


METHODS
A program to prevent venous thromboembolism developed from American College of Chest Physicians guidelines, and an altered work process directed by a computerized reminder system.


METHODS
Rates of symptomatic, objectively confirmed deep vein thrombosis (DVT), pulmonary embolism (PE), and death attributable to venous thromboembolism occurring within 90 days of the date of surgery.


RESULTS
The preintervention and postintervention cohorts did not differ with respect to age, severity of illness, number of risk factors for venous thromboembolism, or individual risk factors for venous thromboembolism. The overall prophylaxis rate increased from 89.9% before implementation of the computerized reminder system to 95.0% after implementation (p < 0.0001). The combined 90-day rate of symptomatic DVT, PE, and death attributable to PE remained the same (preintervention, 1.0%; postintervention, 1.2%; odds ratio, 1.21; 95% confidence interval, 0.67 to 2.20). Forty of 46 venous thromboembolic complications (87%) occurred despite the delivery of American College of Chest Physicians-recommended measures to prevent venous thromboembolism.


CONCLUSIONS
Computerized reminder systems combined with altered care procedures increase the rate of prophylaxis against venous thromboembolism without decreasing the rate of symptomatic venous thromboembolism when the baseline rate of prophylaxis is high. A population of surgical patients exists who are resistant to American College of Chest Physicians-recommended prophylactic measures against venous thromboembolism. New strategies are needed to address prophylaxis-resistant venous thromboembolism.
Mosen
David
D
Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA.
Elliott
C Gregory
CG
Egger
Marlene J
MJ
Mundorff
Michael
M
Hopkins
James
J
Patterson
Robert
R
Gardner
Reed M
RM
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D017010:Reminder Systems; D013813:Therapy, Computer-Assisted; D013923:Thromboembolism / Q000175:diagnosis / Q000517:prevention & control; D020246:Venous Thrombosis / Q000175:diagnosis / Q000517:prevention & control*