title: A clinical decision support system for venous thromboembolism prophylaxis at a general hospital in a middle-income country.
abstract: OBJECTIVE
  To determine the impact that implementing a combination of a computer-based clinical decision support system and a program of training seminars has on the use of appropriate prophylaxis for venous thromboembolism (VTE).
  
  
  METHODS
  We conducted a cross-sectional study in two phases (prior to and after the implementation of the new VTE prophylaxis protocol) in order to evaluate the impact that the combined strategy had on the use of appropriate VTE prophylaxis. The study was conducted at Nossa Senhora da Conceição Hospital, a general hospital in the city of Porto Alegre, Brazil. We included clinical and surgical patients over 18 years of age who were hospitalized for > 48 h. The pre-implementation and post-implementation phase samples comprised 262 and 261 patients, respectively.
  
  
  RESULTS
  The baseline characteristics of the two samples were similar, including the distribution of patients by risk level. Comparing the pre-implementation and post-implementation periods, we found that the overall use of appropriate VTE prophylaxis increased from 46.2% to 57.9% (p = 0.01). Looking at specific patient populations, we observed that the use of appropriate VTE prophylaxis increased more dramatically among cancer patients (from 18.1% to 44.1%; p = 0.002) and among patients with three or more risk factors (from 25.0% to 42.9%; p = 0.008), two populations that benefit most from prophylaxis.
  
  
  CONCLUSIONS
  It is possible to increase the use of appropriate VTE prophylaxis in economically constrained settings through the use of a computerized protocol adhered to by trained professionals. The underutilization of prophylaxis continues to be a major problem, indicative of the need for ongoing improvement in the quality of inpatient care.
authors.affiliation: Nossa Senhora da Conceição Hospital and Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil. ferfuzi@hotmail.com
authors.forename: Fernanda
authors.initials: F
authors.lastname: Fuzinatto
authors.forename: Fernando Starosta de
authors.initials: FS
authors.lastname: Waldemar
authors.forename: André
authors.initials: A
authors.lastname: Wajner
authors.forename: Cesar Al Alam
authors.initials: CA
authors.lastname: Elias
authors.forename: Juliana Fernándes
authors.initials: JF
authors.lastname: Fernandez
authors.forename: João Luiz de Souza
authors.initials: JL
authors.lastname: Hopf
authors.forename: Sergio Saldanha Menna
authors.initials: SS
authors.lastname: Barreto
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001938:Brazil; D002985:Clinical Protocols / Q000592:standards*; D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical / Q000592:standards*; D005260:Female; D006282:Health Personnel / Q000193:education; D006493:Heparin / Q000627:therapeutic use*; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin