title: A simple reminder system improves venous thromboembolism prophylaxis rates and reduces thrombotic events for hospitalized patients1.
abstract: BACKGROUND
  Compliance with venous thromboembolism (VTE) prophylaxis is poor.
  
  
  OBJECTIVE
  We sought to determine whether a simple electronic reminder applicable to all hospitalized patients would increase prophylaxis rates and reduce VTE rates.
  
  
  METHODS
  An electronic reminder was added to the electronic medical record admission note used by all services in our hospital. Prophylaxis, VTE and bleeding rates before and after implementation were compared. Data were analyzed with sas version 9.1.
  
  
  RESULTS
  Among all adult medical and surgical patients admitted to our hospital during the time periods studied, 42.8% (1236/2888) before and 60.0% (1410/2350) after the reminder was added received appropriate prophylaxis as per American College of Chest Physicians (ACCP) guidelines (P < 0.001). The difference reached significance for both medical (51.0% vs. 68.9%; P < 0.001) and surgical (48.0% vs. 61.0%; P < 0.001) services. Fewer patients were diagnosed with VTE after our reminder was added (1.1% vs. 0.3%; P = 0.001), and there was a trend towards fewer bleeds (1.1% vs. 0.6%; P = 0.09). The presence of the reminder was an independent predictor for prophylaxis being given (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.70-2.18; P < 0.001), and was independently associated with a decreased risk for VTE (OR 0.30, 95% CI 0.14-0.64; P = 0.003) after adjustment for other VTE risk factors.
  
  
  CONCLUSIONS
  Adding an electronic reminder to the admission note improved prophylaxis rates and reduced VTE rates across services. The system is easily reproducible and applicable to other facilities. The improvement obtained was modest, so additional measures will probably be needed to optimize prophylaxis rates.
authors.affiliation: Department of Internal Medicine, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Mitchell
authors.forename: J F
authors.initials: JF
authors.lastname: Collen
authors.forename: S
authors.initials: S
authors.lastname: Petteys
authors.forename: A B
authors.initials: AB
authors.lastname: Holley
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced; D006772:Hospitals, Military; D006801:Humans; D016015:Logistic Models; D008297:Male; D008396:Maryland; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents