Effects of clinical decision support on venous thromboembolism risk assessment, prophylaxis, and prevention at a university teaching hospital.
OBJECTIVE
The implementation of a mandatory assessment of risk for venous thromboembolism (VTE) in a health system's electronic medical record (EMR) and clinical decision-support (CDS) system was evaluated to measure its effect on the use of pharmacologic prophylaxis and the occurrence of VTE and bleeding events.


METHODS
A commercially available CDS system was used in designing the automated CDS intervention. During computerized order entry, the system delivered alerts prompting clinician risk assessment and also delivered alerts under circumstances suggesting less-than-optimal prophylaxis. Rates of pharmacologic prophylaxis, clinically diagnosed hospital-acquired VTE, and hospital-acquired bleeding events were measured during one year before and one year after implementation.


RESULTS
After adjustment for patient age, sex, and high-risk comorbidities, the data showed a postimplementation increase in the percentage of patients who received pharmacologic prophylaxis at some time during their admission from 25.9% to 36.8% (p < 0.001). The rate of VTE for the entire hospital did not change significantly, but a significant reduction among patients on medical units was observed, from 0.55% to 0.33% (p = 0.02). There was no increase in either major or minor bleeding events.


CONCLUSIONS
Without increasing the risk of bleeding, a CDS system requiring clinicians to document VTE risk assessment in the EMR promoted improved rates of pharmacologic prophylaxis at any time during an admission and a decreased risk of VTE in general medical patients but not all adult patients.
Galanter
William L
WL
College of Medicine, Section of General Internal Medicine,and University of Illinois Hospital Information Services, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL 60612, USA.
Thambi
Mathew
M
Rosencranz
Holly
H
Shah
Bobby
B
Falck
Suzanne
S
Lin
Fang-Ju
FJ
Nutescu
Edith
E
Lambert
Bruce
B
D000328:Adult; D000367:Age Factors; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002985:Clinical Protocols; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000458:organization & administration; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants