title: Electronic alerts for hospitalized high-VTE risk patients not receiving prophylaxis: a cohort study.
abstract: BACKGROUND
  Despite existing consensus guidelines, venous thromboembolism (VTE) prophylaxis is underused in high-risk hospitalized patients. The present study evaluated the effects of an electronic alert to the responsible physician in a cohort of hospitalized high-risk patients not receiving VTE prophylaxis.
  
  
  METHODS
  The absence of VTE prophylaxis orders in hospitalized patients at high-risk for VTE triggered an electronic alert to the responsible physician. We studied a cohort of 866 patients whose physicians were alerted that their patients were at high-risk but receiving no VTE prophylaxis. The electronic alert recommended that the responsible physician order preventive measures. We followed each patient for 90 days to determine whether imaging-confirmed symptomatic VTE occurred.
  
  
  RESULTS
  9,527 patients were identified as high-risk for VTE. 9% (866) were not receiving prophylaxis, compared with 18% in the intervention arm of a previous randomized trial (P < 0.001). In our current cohort study, 82% (713) of patients were Medical Service patients. Physician response to alerts resulted in prophylactic measures for 37.7% of those alerted. Symptomatic VTE at 90 days occurred in 5.1% of patients in the present cohort group.
  
  
  CONCLUSIONS
  Implementation of a computer alert program increased prophylaxis rates. However, the majority of alerted physicians in the cohort study did not order VTE prophylaxis despite the alerts. Therefore, novel strategies must be employed to further improve the use of VTE prophylaxis in hospitalized high-risk patients, especially in Medical Service patients.
authors.affiliation: Pharmacy, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. sbaroletti@partners.org
authors.forename: Steven
authors.initials: S
authors.lastname: Baroletti
authors.forename: Kristin
authors.initials: K
authors.lastname: Munz
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sonis
authors.forename: John
authors.initials: J
authors.lastname: Fanikos
authors.forename: Karen
authors.initials: K
authors.lastname: Fiumara
authors.forename: Marilyn
authors.initials: M
authors.lastname: Paterno
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D055656:Prescriptions / Q000706:statistics & numerical data*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*