Electronic Alerts, Comparative Practitioner Metrics, and Education Improves Thromboprophylaxis and Reduces Thrombosis.
BACKGROUND
Venous thromboembolism chemoprophylaxis remains underutilized in hospitalized medical patients at high risk for venous thromboembolism. We assessed the effect of a health care quality-improvement initiative comprised of a targeted electronic alert, comparative practitioner metrics, and practitioner-specific continuing medical education on the rate of appropriate venous thromboembolism chemoprophylaxis provided to medical inpatients at high risk for venous thromboembolism.


METHODS
We performed a multicenter prospective observational cohort study in an urban Utah hospital system. All medical patients admitted to 1 of 2 participating hospitals from April 1, 2010 to December 31, 2012 were eligible. Patients were members of the "control" (April 1, 2010 to December 31, 2010), "intervention" (January 1, 2011 to December 31, 2011), or "subsequent year" (January 1, 2012 to December 31, 2012) group. The primary outcome was the rate of appropriate chemoprophylaxis among patients at high risk for venous thromboembolism. Secondary outcomes included rates of symptomatic venous thromboembolism, major bleeding, all-cause mortality, heparin-induced thrombocytopenia, physician satisfaction, and alert fatigue.


RESULTS
The rate of appropriate chemoprophylaxis among patients at high risk for venous thromboembolism increased (66.1% control period vs 81.0% intervention period vs 88.1% subsequent year; P <.001 for each comparison). A significant reduction of 90-day symptomatic venous thromboembolism accompanied the quality initiative (9.3% control period, 9.7% intervention period, 6.7% subsequent year; P = .009); 30-day venous thromboembolism rates also significantly decreased.


CONCLUSIONS
A multifaceted intervention was associated with increased appropriate venous thromboembolism chemoprophylaxis among medical inpatients at high risk for venous thromboembolism and reduced symptomatic venous thromboembolism. The effect of the intervention was sustained.
Intermountain Medical Center, Murray, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City. Electronic address: scott.woller@imail.org.
Scott C
SC
Woller
Intermountain Medical Center, Murray, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.
Scott M
SM
Stevens
Department of Medical Informatics, Intermountain Healthcare, Murray, Utah; Department of Biomedical Informatics, University of Utah, Salt Lake City.
R Scott
RS
Evans
Twine Clinical Consulting, LLC, Park City, Utah.
Daniel G
DG
Wray
Intermountain Medical Center, Murray, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.
John C
JC
Christensen
Intermountain Medical Center, Murray, Utah.
Valerie T
VT
Aston
Medical Impact Ventures, LLC, Austin, Tex.
Matthew H
MH
Wayne
Department of Medical Informatics, Intermountain Healthcare, Murray, Utah.
James F
JF
Lloyd
Division of Statistics, Intermountain Medical Center, Murray, Utah.
Emily L
EL
Wilson
Intermountain Medical Center, Murray, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.
C Gregory
CG
Elliott
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D018890:Chemoprevention / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement; D013921:Thrombocytopenia / Q000139:chemically induced; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin
Chemoprophylaxis medical patient; Prevention; Quality improvement; Venous thromboembolism