title: Impact of electronic reminders on venous thromboprophylaxis after admissions and transfers.
abstract: OBJECTIVE
  Clinical decision support has the potential to improve prevention of venous thromboembolism (VTE). The purpose of this prospective study was to analyze the effect of electronic reminders on thromboprophylaxis rates in wards to which patients were admitted and transferred. The latter was of particular interest since patient handoffs are considered to be critical safety issues.
  
  
  METHODS
  The trial involved two study periods in the six departments of a university hospital, three of which were randomly assigned to the intervention group displaying reminders during the second period. At 6 h after admission or transfer, the algorithm checked for prophylaxis orders within 0-30 h of the patient's arrival, increasing the specificity of the displayed reminders.
  
  
  RESULTS
  The significant impact of the reminders could be seen by prophylaxis orders placed 6-24 h after admission (increasing from 8.6% (223/2579) to 12% (307/2555); p<0.0001) and transfer (increasing from 2.4% (39/1616) to 3.7% (63/1682); p=0.034). In admission wards, the rate of thromboprophylaxis increased from 62.4% to 67.7% (p<0.0001), and in transfer wards it increased from 80.2% to 84.3% (p=0.0022). Overall, the rate of prophylaxis significantly increased in the intervention group from 69.2% to 74.3% (p<0.0001). No significant changes were observed in the control group. Postponing prophylaxis checks to 6 h after admissions and transfers reduced the number of reminders by 62% and thereby minimized the risk of alert fatigue.
  
  
  CONCLUSIONS
  The reminders improved awareness of VTE prevention in both admission and transfer wards. This approach may contribute to better quality of care and safer patient handoffs.
authors.affiliation: Research Center for Medical Informatics, University Hospital Zurich, Zurich, Switzerland.
authors.forename: P E
authors.initials: PE
authors.lastname: Beeler
authors.affiliation: Research Center for Medical Informatics, University Hospital Zurich, Zurich, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Eschmann
authors.affiliation: Division of Angiology, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Schumacher
authors.affiliation: Division of Hematology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: J-D
authors.initials: JD
authors.lastname: Studt
authors.affiliation: Division of Angiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Amann-Vesti
authors.affiliation: Research Center for Medical Informatics, University Hospital Zurich, Zurich, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Blaser
mesh_terms: D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use*; D006785:Hospitals, University; D006801:Humans; D050316:Medical Order Entry Systems; D010343:Patient Admission; D062209:Patient Handoff; D011446:Prospective Studies; D017010:Reminder Systems; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Clinical; Decision Support Systems; Patient Handoff; Patient Transfer; Reminder Systems; Venous Thromboembolism