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28-12-2011 | Cardiology | Article

Computerized reminders improve VTE prophylaxis rates


Meeting website

MedWire News: A computerized decision-making tool that reminds physicians to order venous thromboembolism (VTE) prophylaxis reduces the rate of post-hospital discharge thrombosis without increasing bleeding, US researchers report.

Speaking at the 53rd American Society of Hematology Annual Meeting and Exposition in San Diego, California, USA, Amer Zeidan (The Johns Hopkins University, Baltimore, Maryland) said that even though VTE prophylaxis can reduce VTE risk by 60%, many patients still do not receive appropriate preventive therapy.

To improve VTE prophylaxis rates at The Johns Hopkins Hospital, Zeidan and team developed mandatory computer decision support "smart ordersets" (ie, electronic menus with VTE prophylaxis recommendations).

The ordersets require providers to respond to two questions that assess VTE risk factors and contraindications to pharmacologic prophylaxis, Zeidan explained.

Using these answers along with known patient demographics, the orderset gives providers an evidence-based risk-appropriate VTE prophylaxis recommendation: 5000 units of subcutaneous heparin twice daily for patients with no major risk factors; 5000 units three times daily for patients with at least one major risk factor; or mechanical prophylaxis for those with a contraindication to heparin.

To study the impact of the ordersets on compliance with the 2008 American College of Chest Physicians (ACCP) VTE prophylaxis guideline and clinical outcomes, Zeidan and colleagues conducted a retrospective review of patients admitted to the hospital's Medicine service during 1 month immediately prior to (November 2007; n=1025 patients) and 1 month after (April 2010; n=1057) orderset launch.

Zeiden reported thatACCP compliant prophylaxis increased significantly from 68.3% before to 85.9% after the introduction of the ordersets.

This was mainly due to a significant increase in mechanical prophylaxis, which rose from 6.0% before to 19.4% after the system's launch.

Prescriptions for twice-daily heparin also increased significantly, from 13.9% before to 29.9% following the intervention. But this was partly offset by a significant decline in the percentage of patients given heparin three times daily (44.0% before versus 35.3% after), Zeidan said.

In addition, radiographically confirmed symptomatic VTE by 90 days post-hospital discharge declined significantly from 2.8% to 0.7% after orderset implementation, without increasing major bleeding. Specifically, major bleeding was observed in 0.3% before the smart ordersets were implemented and in 0.1% afterwards.

"Our results support the use of a mandated risk-adaptive strategy for consideration of VTE prophylaxis for every hospitalized patient," Zeidan concluded.

By Laura Dean

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