Improved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical decision support tool for prophylaxis for venous thromboembolism in trauma.
OBJECTIVE
Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients.


METHODS
Retrospective cohort study (from January 2007 through December 2010).


METHODS
University-based, state-designated level 1 adult trauma center.


METHODS
A total of 1599 hospitalized adult trauma patients with a hospital length of stay greater than 1 day.


METHODS
The primary outcome measure was the proportion of patients who were ordered risk-appropriate guideline-suggested VTE prophylaxis. The secondary outcome measure was the proportion of patients with any preventable VTE (defined as VTE in a patient not ordered guideline-appropriate VTE prophylaxis), pulmonary embolism, and/or deep vein thrombosis.


RESULTS
Compliance with guideline-appropriate prophylaxis increased from 66.2% to 84.4% (P < .001). The rate of preventable harm from VTE decreased from 1.0% to 0.17% (P = .04).


CONCLUSIONS
Implementation of a mandatory computerized provider order entry-based clinical decision support tool significantly improved compliance with VTE prophylaxis guidelines in hospitalized adult trauma patients. This improved compliance was associated with a significant decrease in the rate of preventable harm, which was defined as VTE events in patients not ordered appropriate prophylaxis.
The Armstrong Institute for Patient Safety; Division of Acute Care Surgery, Departmen of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. ehaut1@jhmi.edu
Elliott R
ER
Haut
Brandyn D
BD
Lau
Franca S
FS
Kraenzlin
Deborah B
DB
Hobson
Peggy S
PS
Kraus
Howard T
HT
Carolan
Adil H
AH
Haider
Christine G
CG
Holzmueller
David T
DT
Efron
Peter J
PJ
Pronovost
Michael B
MB
Streiff
D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D037141:Mandatory Programs / Q000458:organization & administration*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012308:Risk Management / Q000379:methods* / Q000458:organization & administration; D016896:Treatment Outcome; D014481:United States; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery*