title: Physician compliance with advanced electronic alerts for preventing venous thromboembolism among hospitalized medical patients.
abstract: BACKGROUND
  Worldwide, more than half of the hospitalized medical patients at high risk do not receive venous thromboembolism (VTE) prophylaxis. Although VTE among hospitalized patients at risk is reduced with electronic alerts (eAlerts), the majority of eAlerts are being ignored by the responsible physician.
  
  
  METHODS
  We investigated physician compliance with an advanced eAlert system in 1027 (age 59 +/- 17 years) hospitalized medical patients. A continuously flashing non-interruptive eAlert, visible to all healthcare professionals, was issued in the electronic patient chart 6 h after admission if the physician did not order prophylaxis.
  
  
  RESULTS
  The rate of appropriate prophylaxis increased from 44% before to 76% after the implementation of the eAlert system. Although the patients whose physicians cared for > or = 20 patients during the study period had a more frequent physician response to the eAlert than patients whose physicians cared for fewer patients (69% vs. 40%, P < 0.001), they received appropriate prophylaxis less often (72% vs. 81%, P = 0.016). After adjustment for significant patient predictors of appropriate prophylaxis, including cancer, age, duration of hospital stay, and thrombocytopenia, patients whose physicians cared for > or = 20 patients during the study period were less likely to receive appropriate prophylaxis (odds ratio 0.65, 95% confidence interval 0.44-0.96; P = 0.032) than patients whose physicians cared for fewer patients.
  
  
  CONCLUSIONS
  The introduction of an advanced eAlert system accompanied by continuing medical education for the prevention of VTE resulted in a substantial increase in the rate of appropriate prophylaxis among hospitalized medical patients. However, many eAlerts may cause decreased physician compliance owing to 'alert fatigue'.
authors.affiliation: Venous Thromboembolism Research Group, Cardiovascular Division, Department of Medicine, Cardiovascular Centre, University Hospital Zurich, Zurich, Switzerland. nils.kucher@usz.ch
authors.forename: N
authors.initials: N
authors.lastname: Kucher
authors.forename: M
authors.initials: M
authors.lastname: Puck
authors.forename: J
authors.initials: J
authors.lastname: Blaser
authors.forename: G
authors.initials: G
authors.lastname: Bucklar
authors.forename: E
authors.initials: E
authors.lastname: Eschmann
authors.forename: T F
authors.initials: TF
authors.lastname: Lüscher
mesh_terms: D000328:Adult; D000368:Aged; D018890:Chemoprevention / Q000379:methods; D004502:Education, Medical, Continuing; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D054556:Venous Thromboembolism / Q000517:prevention & control*