Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program.
OBJECTIVE
Deep vein thrombosis (DVT) is a major source of postoperative morbidity and mortality and is currently a major quality improvement initiative. Mechanical and pharmacological prophylaxis is effective in preventing postoperative thromboembolic events, yet it remains underutilized in the clinical setting. Thus, the objective of this study was to develop and implement a computerized DVT risk assessment program in the electronic medical record and determine its effect on compliance with DVT prophylaxis guidelines.


METHODS
A standardized DVT risk assessment program was developed and incorporated into the Computerized Patient Record System for all surgical patients at the Jesse Brown Veterans Affairs Medical Center. Four hundred consecutive surgical patients before and after implementation were evaluated for DVT risk, the prescription of pharmacological and mechanical DVT prophylaxis, and the development of thromboembolic events.


RESULTS
With implementation of the DVT risk assessment program, the number of patients receiving the recommended pharmacological prophylaxis preoperatively more than doubled (14% to 36%) (P < .001), and use of sequential compression devices (SCD) increased 40% (P < .001). Overall, the percentage of at-risk patients receiving the recommended combined DVT prophylaxis of SCD and pharmacological prophylaxis increased nearly seven-fold (5% to 32%) (P < .001). The assessment also improved use of prophylaxis postoperatively, increasing SCD use by 27% (P < .001). With respect to DVT occurrence, there was an 80% decrease in the incidence of postoperative DVT at 30 days and a 36% decrease at 90 days; however, this did not reach statistical significance due to the low event rate.


CONCLUSIONS
The creation and implementation of a standardized DVT risk assessment program in the electronic medical record significantly increased use of pharmacological and mechanical DVT prophylaxis before surgery in a Veterans Affairs Medical Center setting.
Novis
Sarah Jane
SJ
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Havelka
George E
GE
Ostrowski
Denise
D
Levin
Betsy
B
Blum-Eisa
Laurie
L
Prystowsky
Jay B
JB
Kibbe
Melina R
MR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001331:Automation; D020000:Decision Support Systems, Clinical; D004363:Drug Utilization; D004434:Early Ambulation / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019983:Guideline Adherence; D006787:Hospitals, Veterans; D006801:Humans; D007087:Illinois; D048228:Intermittent Pneumatic Compression Devices / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D017010:Reminder Systems; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
D005343:Fibrinolytic Agents