Improving hospital venous thromboembolism prophylaxis with electronic decision support.

Background: Venous thromboembolism (VTE) disease prophylaxis rates among medical inpatients have been noted to be <50%.
Objective: Our objective was to evaluate the effectiveness and safety of a computerized decision support application to improve VTE prophylaxis.
Design: Observational cohort study.
Setting: Academic medical center.
Patients: Adult inpatients on hospital medicine and nonmedicine services.
Intervention: A decision support application designed by a quality improvement team was implemented on medicine services in September 2009.
Measurements: Effectiveness and safety parameters were compared on medicine services and nonmedicine (nonimplementation) services for 6-month periods before and after implementation. Effectiveness was evaluated by retrospective information system queries for rates of any VTE prophylaxis, pharmacologic VTE prophylaxis, and hospital-acquired VTE incidence. Safety was evaluated by queries for bleeding and thrombocytopenia rates.
Results: Medicine service overall VTE prophylaxis increased from 61.9% to 82.1% (P < 0.001), and pharmacologic VTE prophylaxis increased from 59.0% to 74.5% (P < 0.001). Smaller but significant increases were observed on nonmedicine services. Hospital-acquired VTE incidence on medicine services decreased significantly from 0.65% to 0.42% (P = 0.008) and nonsignificantly on nonmedicine services. Bleeding rates increased from 2.9% to 4.0% (P < 0.001) on medicine services and from 7.7% to 8.6% (P = 0.043) on nonmedicine services, with nonsignificant changes in thrombocytopenia rates observed on both services.
Conclusions: An electronic decision support application on inpatient medicine services can significantly improve VTE prophylaxis and hospital-acquired VTE rates with a reasonable safety profile.
(Copyright © 2012 Society of Hospital Medicine.)