title: Impact of a venous thromboembolism prophylaxis "smart order set": Improved compliance, fewer events.
abstract: Venous thromboembolism (VTE) affects over 700,000 Americans annually. Prophylaxis reduces the risk of VTE by 60% but many patients still do not receive risk-appropriate VTE prophylaxis. To improve our institution's VTE prophylaxis performance, we developed mandatory computerized clinical decision support-enabled "smart order sets" that required providers to assess VTE risk factors and contraindications to pharmacologic prophylaxis. Using provider responses, the order set recommends evidence-based risk-appropriate VTE prophylaxis. To study the impact of our "smart order set" on prescription of risk-appropriate VTE prophylaxis and clinical outcomes, we conducted a retrospective chart review of consecutive patients admitted to the Medicine service during one month immediately prior to (November 2007) and a single month subsequent to (April 2010) order set launch. Data collection included patient demographics, VTE risk factors, and the use and type of VTE prophylaxis. The pre- and post-implementation cohorts contained 1,000 and 942 patients, respectively. After implementation of the "smart order set", the prescription of risk-appropriate VTE prophylaxis increased from 65.6% to 90.1% (P < 0.0001). Orders for any form of VTE prophylaxis increased from 76.4% to 95.6% (P < 0.0001). Radiographically documented symptomatic VTE within 90 days of hospital discharge declined from 2.5% to 0.7% (P = 0.002). Preventable harm was completely eliminated (1.1% to 0%, P = 0.001) with no difference in major bleeding or all-cause mortality. A VTE prophylaxis computerized clinical decision support-enabled "smart order set" improved prescription of risk-appropriate VTE prophylaxis, reduced symptomatic VTE and eliminated preventable harm from VTE without increasing major bleeding.
authors.affiliation: Division of Hematology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland 21205.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
authors.forename: Brandyn D
authors.initials: BD
authors.lastname: Lau
authors.forename: Syed-Rafay
authors.initials: SR
authors.lastname: Ahmed
authors.forename: Peggy S
authors.initials: PS
authors.lastname: Kraus
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Hobson
authors.forename: Howard
authors.initials: H
authors.lastname: Carolan
authors.forename: Chryso
authors.initials: C
authors.lastname: Lambrianidi
authors.forename: Paula B
authors.initials: PB
authors.lastname: Horn
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Shermock
authors.forename: Gabriel
authors.initials: G
authors.lastname: Tinoco
authors.forename: Salahuddin
authors.initials: S
authors.lastname: Siddiqui
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000517:prevention & control*; D006493:Heparin / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin