Lessons from the Johns Hopkins Multi-Disciplinary Venous Thromboembolism (VTE) Prevention Collaborative.
OBJECTIVE
Venous thromboembolism (VTE) is a common cause of potentially preventable mortality, morbidity, and increased medical costs. Risk-appropriate prophylaxis can prevent most VTE events, but only a small fraction of patients at risk receive this treatment.


METHODS
Prospective quality improvement programme.


METHODS
Johns Hopkins Hospital, Baltimore, Maryland, USA.


METHODS
A multidisciplinary team established a VTE Prevention Collaborative in 2005. The collaborative applied the four step TRIP (translating research into practice) model to develop and implement a mandatory clinical decision support tool for VTE risk stratification and risk-appropriate VTE prophylaxis for all hospitalised adult patients. Initially, paper based VTE order sets were implemented, which were then converted into 16 specialty-specific, mandatory, computerised, clinical decision support modules.


METHODS
VTE risk stratification within 24 hours of hospital admission and provision of risk-appropriate, evidence based VTE prophylaxis.


RESULTS
The VTE team was able to increase VTE risk assessment and ordering of risk-appropriate prophylaxis with paper based order sets to a limited extent, but achieved higher compliance with a computerised clinical decision support tool and the data feedback which it enabled. Risk-appropriate VTE prophylaxis increased from 26% to 80% for surgical patients and from 25% to 92% for medical patients in 2011.


CONCLUSIONS
A computerised clinical decision support tool can increase VTE risk stratification and risk-appropriate VTE prophylaxis among hospitalised adult patients admitted to a large urban academic medical centre. It is important to ensure the tool is part of the clinician's normal workflow, is mandatory (computerised forcing function), and offers the requisite modules needed for every clinical specialty.
Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Michael B
MB
Streiff
Howard T
HT
Carolan
Deborah B
DB
Hobson
Peggy S
PS
Kraus
Christine G
CG
Holzmueller
Renee
R
Demski
Brandyn D
BD
Lau
Paula
P
Biscup-Horn
Peter J
PJ
Pronovost
Elliott R
ER
Haut
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D015142:Baltimore; D003299:Cooperative Behavior; D003658:Decision Making, Computer-Assisted; D019317:Evidence-Based Medicine; D006760:Hospitalization; D006801:Humans; D050316:Medical Order Entry Systems / Q000458:organization & administration; D009936:Organizational Innovation; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement; D018570:Risk Assessment; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*
D000925:Anticoagulants