Improved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical decision support tool for prophylaxis for venous thromboembolism in trauma

Elliott Haut, Brandyn Lau, Franca S. Kraenzlin, Deborah B. Hobson, Peggy S. Kraus, Howard T. Carolan, Adil H. Haider, Christine G. Holzmueller, David Thomas Efron, Peter J. Pronovost, Michael B Streiff

Research output: Contribution to journalArticle

Abstract

Objective: Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients. Design: Retrospective cohort study (from January 2007 through December 2010). Setting: University-based, state-designated level 1 adult trauma center. Patients: A total of 1599 hospitalized adult trauma patients with a hospital length of stay greater than 1 day. Main Outcome Measures: The primary outcome measure was the proportion of patients whowere ordered riskappropriate guideline-suggestedVTEprophylaxis. The secondary outcome measure was the proportion of patients with any preventable VTE (defined as VTE in a patient not ordered guideline-appropriate VTE prophylaxis), pulmonary embolism, and/or deep vein thrombosis. Results: Compliance with guideline-appropriate prophylaxis increased from 66.2% to 84.4% (P <.001). The rate of preventable harm from VTE decreased from 1.0% to 0.17% (P =.04). Conclusions: Implementation of a mandatory computerized provider order entry-based clinical decision support tool significantly improved compliance with VTE prophylaxis guidelines in hospitalized adult trauma patients. This improved compliance was associated with a significant decrease in the rate of preventable harm, which was defined as VTE events in patients not ordered appropriate prophylaxis.

Original languageEnglish (US)
Pages (from-to)901-907
Number of pages7
JournalArchives of Surgery
Volume147
Issue number10
DOIs
StatePublished - Oct 2012

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Clinical Decision Support Systems
Venous Thromboembolism
Wounds and Injuries
Medical Order Entry Systems
Guidelines
Outcome Assessment (Health Care)
Length of Stay
Trauma Centers
Checklist
Pulmonary Embolism
Practice Guidelines
Venous Thrombosis
Compliance

ASJC Scopus subject areas

  • Surgery

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Improved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical decision support tool for prophylaxis for venous thromboembolism in trauma. / Haut, Elliott; Lau, Brandyn; Kraenzlin, Franca S.; Hobson, Deborah B.; Kraus, Peggy S.; Carolan, Howard T.; Haider, Adil H.; Holzmueller, Christine G.; Efron, David Thomas; Pronovost, Peter J.; Streiff, Michael B.

In: Archives of Surgery, Vol. 147, No. 10, 10.2012, p. 901-907.

Research output: Contribution to journalArticle

Haut, Elliott ; Lau, Brandyn ; Kraenzlin, Franca S. ; Hobson, Deborah B. ; Kraus, Peggy S. ; Carolan, Howard T. ; Haider, Adil H. ; Holzmueller, Christine G. ; Efron, David Thomas ; Pronovost, Peter J. ; Streiff, Michael B. / Improved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical decision support tool for prophylaxis for venous thromboembolism in trauma. In: Archives of Surgery. 2012 ; Vol. 147, No. 10. pp. 901-907.
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abstract = "Objective: Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients. Design: Retrospective cohort study (from January 2007 through December 2010). Setting: University-based, state-designated level 1 adult trauma center. Patients: A total of 1599 hospitalized adult trauma patients with a hospital length of stay greater than 1 day. Main Outcome Measures: The primary outcome measure was the proportion of patients whowere ordered riskappropriate guideline-suggestedVTEprophylaxis. The secondary outcome measure was the proportion of patients with any preventable VTE (defined as VTE in a patient not ordered guideline-appropriate VTE prophylaxis), pulmonary embolism, and/or deep vein thrombosis. Results: Compliance with guideline-appropriate prophylaxis increased from 66.2{\%} to 84.4{\%} (P <.001). The rate of preventable harm from VTE decreased from 1.0{\%} to 0.17{\%} (P =.04). Conclusions: Implementation of a mandatory computerized provider order entry-based clinical decision support tool significantly improved compliance with VTE prophylaxis guidelines in hospitalized adult trauma patients. This improved compliance was associated with a significant decrease in the rate of preventable harm, which was defined as VTE events in patients not ordered appropriate prophylaxis.",
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T1 - Improved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical decision support tool for prophylaxis for venous thromboembolism in trauma

AU - Haut, Elliott

AU - Lau, Brandyn

AU - Kraenzlin, Franca S.

AU - Hobson, Deborah B.

AU - Kraus, Peggy S.

AU - Carolan, Howard T.

AU - Haider, Adil H.

AU - Holzmueller, Christine G.

AU - Efron, David Thomas

AU - Pronovost, Peter J.

AU - Streiff, Michael B

PY - 2012/10

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N2 - Objective: Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients. Design: Retrospective cohort study (from January 2007 through December 2010). Setting: University-based, state-designated level 1 adult trauma center. Patients: A total of 1599 hospitalized adult trauma patients with a hospital length of stay greater than 1 day. Main Outcome Measures: The primary outcome measure was the proportion of patients whowere ordered riskappropriate guideline-suggestedVTEprophylaxis. The secondary outcome measure was the proportion of patients with any preventable VTE (defined as VTE in a patient not ordered guideline-appropriate VTE prophylaxis), pulmonary embolism, and/or deep vein thrombosis. Results: Compliance with guideline-appropriate prophylaxis increased from 66.2% to 84.4% (P <.001). The rate of preventable harm from VTE decreased from 1.0% to 0.17% (P =.04). Conclusions: Implementation of a mandatory computerized provider order entry-based clinical decision support tool significantly improved compliance with VTE prophylaxis guidelines in hospitalized adult trauma patients. This improved compliance was associated with a significant decrease in the rate of preventable harm, which was defined as VTE events in patients not ordered appropriate prophylaxis.

AB - Objective: Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients. Design: Retrospective cohort study (from January 2007 through December 2010). Setting: University-based, state-designated level 1 adult trauma center. Patients: A total of 1599 hospitalized adult trauma patients with a hospital length of stay greater than 1 day. Main Outcome Measures: The primary outcome measure was the proportion of patients whowere ordered riskappropriate guideline-suggestedVTEprophylaxis. The secondary outcome measure was the proportion of patients with any preventable VTE (defined as VTE in a patient not ordered guideline-appropriate VTE prophylaxis), pulmonary embolism, and/or deep vein thrombosis. Results: Compliance with guideline-appropriate prophylaxis increased from 66.2% to 84.4% (P <.001). The rate of preventable harm from VTE decreased from 1.0% to 0.17% (P =.04). Conclusions: Implementation of a mandatory computerized provider order entry-based clinical decision support tool significantly improved compliance with VTE prophylaxis guidelines in hospitalized adult trauma patients. This improved compliance was associated with a significant decrease in the rate of preventable harm, which was defined as VTE events in patients not ordered appropriate prophylaxis.

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