title: Computerized Clinical Decision Support to Prevent Venous Thromboembolism Among Hospitalized Patients: Proximal Outcomes from a Multiyear Quality Improvement Project.
abstract: Despite venous thromboembolism (VTE) policy initiatives, gaps exist between guidelines and practice. In response, hospitals implement clinical decision support (CDS) systems to improve VTE prophylaxis. To assess the impact of a VTE CDS on reducing incidence of VTE, this study used a pretest/posttest, longitudinal, cohort design incorporating electronic health record (EHR) data from one urban tertiary and level 1 trauma center, and one suburban hospital. VTE CDS was embedded into the EHR system. The study included 45,046 admissions; 171,753 patient days; and 110 VTE events. The VTE rate declined from 0.954 per 1,000 patient days to 0.434 comparing baseline to full VTE CDS. Compared to baseline, patients benefitting from VTE CDS were 35% less likely to have a VTE. VTE CDS utilization achieved 78.4% patients assessed within 24 hr from admission, 64.0% patients identified at risk, and 47.7% patients at risk for VTE with an initiated VTE interdisciplinary plan of care. CDS systems with embedded algorithms, alerts, and notification capabilities enable physicians at the point of care to utilize guidelines and make impactful decisions to prevent VTE. This study demonstrates a phased-in implementation of VTE CDS as an effective approach toward VTE prevention. Implications for future research and quality improvement are discussed as well.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Amland
authors.forename: Bonnie B
authors.initials: BB
authors.lastname: Dean
authors.forename: HsingTing
authors.initials: H
authors.lastname: Yu
authors.forename: Hugh
authors.initials: H
authors.lastname: Ryan
authors.forename: Timothy
authors.initials: T
authors.lastname: Orsund
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hackman
authors.forename: Shauna R
authors.initials: SR
authors.lastname: Roberts
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008923:Missouri; D058996:Quality Improvement / Q000458:organization & administration; D018570:Risk Assessment / Q000379:methods; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*