Physician alerts to prevent symptomatic venous thromboembolism in hospitalized patients.
BACKGROUND
Venous thromboembolism (VTE) prophylaxis remains underused among hospitalized patients. We designed and carried out a large, multicenter, randomized controlled trial to test the hypothesis that an alert from a hospital staff member to the attending physician will reduce the rate of symptomatic VTE among high-risk patients not receiving prophylaxis.


RESULTS
We enrolled patients using a validated point score system to detect hospitalized patients at high risk for symptomatic VTE who were not receiving prophylaxis. We randomized 2493 patients (82% on Medical Services) from 25 study sites to the intervention group (n=1238), in which the responsible physician was alerted by another hospital staff member, or the control group (n=1255), in which no alert was issued. The primary end point was symptomatic, objectively confirmed VTE within 90 days. Patients whose physicians were alerted were more than twice as likely to receive VTE prophylaxis as control subjects (46.0% versus 20.6%; P<0.0001). The symptomatic VTE rate was lower in the intervention group (2.7% versus 3.4%; hazard ratio, 0.79; 95% CI, 0.50 to 1.25), but the difference did not achieve statistical significance. The rate of major bleeding at 30 days in the alert group was similar to that in the control group (2.1% versus 2.3%; P=0.68).


CONCLUSIONS
A strategy of direct notification of the physician by a staff member increases prophylaxis use and leads to a reduction in the rate of symptomatic VTE in hospitalized patients. However, VTE prophylaxis continues to be underused even after physician notification, especially among Medical Service patients.
Piazza
Gregory
G
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. gpiazza@partners.org
Rosenbaum
Erin J
EJ
Pendergast
William
W
Jacobson
Joseph O
JO
Pendleton
Robert C
RC
McLaren
Gordon D
GD
Elliott
C Gregory
CG
Stevens
Scott M
SM
Patton
William F
WF
Dabbagh
Ousama
O
Paterno
Marilyn D
MD
Catapane
Elaine
E
Li
Zhongzhen
Z
Goldhaber
Samuel Z
SZ
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D020000:Decision Support Systems, Clinical; D005260:Female; D005500:Follow-Up Studies; D006751:Hospital Information Systems; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D017010:Reminder Systems; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control*
D000925:Anticoagulants