title: A human factors approach to improving electronic performance measurement of venous thromboembolism prophylaxis.
abstract: OBJECTIVE
  In 2011, our institution developed a venous thromboembolism (VTE) prophylaxis order set to monitor prophylaxis management through physician-generated risk assessment orders. Prophylaxis rates obtained using the risk assessment orders were falsely low compared with chart review. Our goal was to redesign the order set to increase the percentage of VTE risk assessments ordered, both to improve care and to better reflect performance.
  
  
  METHODS
  Quality Improvement Project.
  
  
  METHODS
  Veterans Health Administration.
  
  
  METHODS
  Patients admitted to acute care and intensive care medical units.
  
  
  METHODS
  Process analysis was used to identify systems failures limiting use of the original order set. The order set was redesigned using a human factors approach.
  
  
  METHODS
  VTE risk assessment orders.
  
  
  RESULTS
  The order set was redesigned to reduce complexity and improve integration into provider workflow. The rate of risk assessment orders placed within 24 h increased from 48.6 to 80.4% (P < 0.001). There was no difference in the actual use of prophylaxis. However, for patients on prophylaxis, the rates of having a documented 'moderate' or 'high' risk assessment within 24 h increased from 66.7 to 95.7% (P < 0.001).
  
  
  CONCLUSIONS
  Using human factor principles to redesign an order set led to a significant increase in the percentage of patients with a risk assessment order placed within 24 h of admission. Although the risk assessments using the redesigned order set better reflected physician performance, it remained an imperfect measure for VTE prophylaxis. New technology used to measure human performance must be evaluated following implementation to assess accuracy.
authors.affiliation: Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA Section of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Molly J
authors.initials: MJ
authors.lastname: Horstman
authors.affiliation: Section of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Cowart
authors.affiliation: Section of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA Department of Pharmacy, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Mcmaster-Baxter
authors.affiliation: Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Barbara W
authors.initials: BW
authors.lastname: Trautner
authors.affiliation: Section of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Diana E
authors.initials: DE
authors.lastname: Stewart
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D006801:Humans; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: performance measurement; quality improvement; venous thromboembolism prophylaxis