title: Sustained impact of electronic alerts on rate of prophylaxis against venous thromboembolism.
abstract: Advanced electronic alerts (eAlerts) and computerised physician order entry (CPOE) increase adequate thromboprophylaxis orders among hospitalised medical patients. It remains unclear whether eAlerts maintain their efficacy over time, after withdrawal of continuing medical education (CME) on eAlerts and on thromboprophylaxis indications from the study staff. We analysed 5,317 hospital cases from the University Hospital Zurich during 2006-2009: 1,854 cases from a medical ward with eAlerts (interventiongroup) and 3,463 cases from a surgical ward without eAlerts (controlgroup). In the intervention group, an eAlert with hospital-specific venous thromboembolism (VTE) prevention guidelines was issued in the electronic patient chart 6 hours after admission if no pharmacological or mechanical thromboprophylaxis had been ordered. Data were analysed for three phases: pre-implementation (phase 1), eAlert implementation with CME (phase 2), and post-implementation without CME (phase3). The rates of thromboprophylaxis in the intervention group were 43.4% in phase 1 and 66.7% in phase 2 (p<0.001), and increased further to 73.6% in phase3 (p=0.011). Early thromboprophylaxis orders within 12 hours after admission were more often placed in phase 2 and 3 as compared to phase 1 (67.1% vs. 52.1%, p<0.001). In the surgical control group, the thromboprophylaxis rates in the three phases were 88.6%, 90.7%, 90.6% (p=0.16). Advanced eAlerts may provide sustained efficacy over time, with stable rates of thromboprophylaxis orders among hospitalised medical patients.
authors.affiliation: Research Center for Medical Informatics, Research and Education, University Hospital Zurich, Switzerland.
authors.forename: Patrick Emanuel
authors.initials: PE
authors.lastname: Beeler
authors.forename: Nils
authors.initials: N
authors.lastname: Kucher
authors.forename: Jürg
authors.initials: J
authors.lastname: Blaser
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D003658:Decision Making, Computer-Assisted; D018572:Disease-Free Survival; D004502:Education, Medical, Continuing; D005240:Feasibility Studies; D019983:Guideline Adherence; D006757:Hospital Units / Q000706:statistics & numerical data; D006801:Humans; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery
chemical_list: D000925:Anticoagulants