title: Implementation of a mandated venous thromboembolism clinical order set improves venous thromboembolism core measures.
abstract: BACKGROUND
  Venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, is a major cause of morbidity and mortality. It results in approximately 300 000 deaths in the United States each year, and two thirds of VTE events are hospital acquired. However, VTE prophylaxis for hospitalized patients remains suboptimal.
  
  
  OBJECTIVE
  Assess the effect of a physician-mandated VTE prophylaxis computerized order set on the rates of hospital acquired VTE.
  
  
  METHODS
  A retrospective prevalence study of hospitalized patients pre- and postimplementation of a mandatory VTE order set. Additionally, the Joint Commission VTE Core Measures data was tracked for improvements postimplementation.
  
  
  RESULTS
  At baseline, 73% of patients received appropriate prophylaxis (n = 148) compared with 90% (n = 192) postintervention (P = 0.015). The percentage of patients who received VTE prophylaxis within 24 hours of arrival at the hospital increased from a baseline of 73% to 93% postimplementation (P = 0.0004). Hospital-acquired VTE prevalence rates decreased from 2% (4 cases) to 0.05% (1 case; P = 0.37) post intervention. The incidence of potentially preventable VTE cases (the Joint Commission's core measure 6) decreased from 3.9% to 0% (P = 0.39). These differences were not statistically significant, but they are clinically significant. These results were also sustained over time.
  
  
  CONCLUSIONS
  This study demonstrates that a mandated physician VTE order set ensures that nearly all patients will be stratified for VTE risk and provided with prophylaxis based on their risk category. Adhering to the evidence-based clinical practice guidelines from the American College of Chest Physicians is effective in improving prophylaxis and decreasing the rate of hospital-acquired VTE in hospitalized patients, and in decreasing the rate of preventable VTE cases based on the Joint Commission's core measure 6.
authors.affiliation: Internal Medicine Resident, University of Minnesota, Minneapolis, MN.
authors.forename: Loren
authors.initials: L
authors.lastname: Khoury
authors.forename: Amish A
authors.initials: AA
authors.lastname: Dangodara
authors.forename: Jung-Ah
authors.initials: JA
authors.lastname: Lee
authors.forename: Marianne
authors.initials: M
authors.lastname: Lovejoy
authors.forename: Alpesh N
authors.initials: AN
authors.lastname: Amin
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D002985:Clinical Protocols; D057286:Electronic Health Records; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants