title: Improving hospital venous thromboembolism prophylaxis with electronic decision support.
abstract: BACKGROUND
  Venous thromboembolism (VTE) disease prophylaxis rates among medical inpatients have been noted to be <50%.
  
  
  OBJECTIVE
  Our objective was to evaluate the effectiveness and safety of a computerized decision support application to improve VTE prophylaxis.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Adult inpatients on hospital medicine and nonmedicine services.
  
  
  METHODS
  A decision support application designed by a quality improvement team was implemented on medicine services in September 2009.
  
  
  METHODS
  Effectiveness and safety parameters were compared on medicine services and nonmedicine (nonimplementation) services for 6-month periods before and after implementation. Effectiveness was evaluated by retrospective information system queries for rates of any VTE prophylaxis, pharmacologic VTE prophylaxis, and hospital-acquired VTE incidence. Safety was evaluated by queries for bleeding and thrombocytopenia rates.
  
  
  RESULTS
  Medicine service overall VTE prophylaxis increased from 61.9% to 82.1% (P < 0.001), and pharmacologic VTE prophylaxis increased from 59.0% to 74.5% (P < 0.001). Smaller but significant increases were observed on nonmedicine services. Hospital-acquired VTE incidence on medicine services decreased significantly from 0.65% to 0.42% (P = 0.008) and nonsignificantly on nonmedicine services. Bleeding rates increased from 2.9% to 4.0% (P < 0.001) on medicine services and from 7.7% to 8.6% (P = 0.043) on nonmedicine services, with nonsignificant changes in thrombocytopenia rates observed on both services.
  
  
  CONCLUSIONS
  An electronic decision support application on inpatient medicine services can significantly improve VTE prophylaxis and hospital-acquired VTE rates with a reasonable safety profile.
authors.affiliation: Department of Medicine, Montefiore Medical Center, Bronx, NY, USA. rbhalla@stamhealth.org
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhalla
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Berger
authors.forename: Stan H
authors.initials: SH
authors.lastname: Reissman
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Yongue
authors.forename: Jason S
authors.initials: JS
authors.lastname: Adelman
authors.forename: Laurie G
authors.initials: LG
authors.lastname: Jacobs
authors.forename: Henny
authors.initials: H
authors.lastname: Billett
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sinnett
authors.forename: Gary
authors.initials: G
authors.lastname: Kalkut
mesh_terms: D000046:Academic Medical Centers / Q000592:standards* / Q000639:trends; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical / Q000592:standards* / Q000639:trends; D006801:Humans; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*