Correlation of venous thromboembolism prophylaxis and electronic medical record alerts with incidence among surgical patients.
Venous thromboembolism events are potentially preventable adverse events. We investigated the effect of interruptions and delays in pharmacologic prophylaxis on venous thromboembolism incidence. Additionally, we evaluated the utility of electronic medical record alerts for venous thromboembolism prophylaxis.



Venous thromboembolisms were identified in surgical patients retrospectively through Core Measure Venous ThromboEmbolism-6-6 and Patient Safety Indicator 12 between November 2013 and March 2015. Venous thromboembolism pharmacologic prophylaxis and prescriber response to electronic medical record alerts were recorded prospectively. Prophylaxis was categorized as continuous, delayed, interrupted, other, and none.



Among 10,318 surgical admissions, there were 131 venous thromboembolisms; 23.7% of the venous thromboembolisms occurred with optimal continuous prophylaxis. Prophylaxis, length of stay, age, and transfer from another hospital were associated with increased venous thromboembolism incidence. Compared with continuous prophylaxis, interruptions were associated with 3 times greater odds of venous thromboembolism. Delays were associated with 2 times greater odds of venous thromboembolism. Electronic medical record alerts occurred in 45.7% of the encounters and were associated with a 2-fold increased venous thromboembolism incidence. Focus groups revealed procedures as the main contributor to interruptions, and workflow disruption as the main limitation of the electronic medical record alerts.



Multidisciplinary strategies to decrease delays and interruptions in venous thromboembolism prophylaxis and optimization of electronic medical record tools for prophylaxis may help decrease rates of preventable venous thromboembolism.
Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA.
Rajesh
R
Ramanathan
Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA.
Nathaniel
N
Lee
Department of Surgery, JPS Health Network, Fort Worth, TX.
Therese M
TM
Duane
Performance Improvement, Virginia Commonwealth University Health System, Richmond, VA.
Zirui
Z
Gu
Department of Pharmacy Services, Virginia Commonwealth University Health System, Richmond, VA.
Natalie
N
Nguyen
Department of Pharmacy Services, Virginia Commonwealth University Health System, Richmond, VA.
Teresa
T
Potter
Performance Improvement, Virginia Commonwealth University Health System, Richmond, VA.
Edna
E
Rensing
Performance Improvement, Virginia Commonwealth University Health System, Richmond, VA.
Renata
R
Sampson
Clinical Informatics, Virginia Commonwealth University Health System, Richmond, VA.
Mandy
M
Burrows
Clinical Informatics, Virginia Commonwealth University Health System, Richmond, VA.
Colin
C
Banas
Performance Improvement, Virginia Commonwealth University Health System, Richmond, VA.
Sarah
S
Hartigan
Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA. Electronic address: amelia.grover@vcuhealth.org.
Amelia
A
Grover
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D016208:Databases, Factual; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods; D016019:Survival Analysis; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*
D000925:Anticoagulants