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Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program.
J Vasc Surg 2010; 51(3):648-54JV

Abstract

OBJECTIVES

Deep vein thrombosis (DVT) is a major source of postoperative morbidity and mortality and is currently a major quality improvement initiative. Mechanical and pharmacological prophylaxis is effective in preventing postoperative thromboembolic events, yet it remains underutilized in the clinical setting. Thus, the objective of this study was to develop and implement a computerized DVT risk assessment program in the electronic medical record and determine its effect on compliance with DVT prophylaxis guidelines.

METHODS

A standardized DVT risk assessment program was developed and incorporated into the Computerized Patient Record System for all surgical patients at the Jesse Brown Veterans Affairs Medical Center. Four hundred consecutive surgical patients before and after implementation were evaluated for DVT risk, the prescription of pharmacological and mechanical DVT prophylaxis, and the development of thromboembolic events.

RESULTS

With implementation of the DVT risk assessment program, the number of patients receiving the recommended pharmacological prophylaxis preoperatively more than doubled (14% to 36%) (P < .001), and use of sequential compression devices (SCD) increased 40% (P < .001). Overall, the percentage of at-risk patients receiving the recommended combined DVT prophylaxis of SCD and pharmacological prophylaxis increased nearly seven-fold (5% to 32%) (P < .001). The assessment also improved use of prophylaxis postoperatively, increasing SCD use by 27% (P < .001). With respect to DVT occurrence, there was an 80% decrease in the incidence of postoperative DVT at 30 days and a 36% decrease at 90 days; however, this did not reach statistical significance due to the low event rate.

CONCLUSIONS

The creation and implementation of a standardized DVT risk assessment program in the electronic medical record significantly increased use of pharmacological and mechanical DVT prophylaxis before surgery in a Veterans Affairs Medical Center setting.

Authors+Show Affiliations

Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20022209

Citation

Novis, Sarah Jane, et al. "Prevention of Thromboembolic Events in Surgical Patients Through the Creation and Implementation of a Computerized Risk Assessment Program." Journal of Vascular Surgery, vol. 51, no. 3, 2010, pp. 648-54.
Novis SJ, Havelka GE, Ostrowski D, et al. Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program. J Vasc Surg. 2010;51(3):648-54.
Novis, S. J., Havelka, G. E., Ostrowski, D., Levin, B., Blum-Eisa, L., Prystowsky, J. B., & Kibbe, M. R. (2010). Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program. Journal of Vascular Surgery, 51(3), pp. 648-54. doi:10.1016/j.jvs.2009.08.097.
Novis SJ, et al. Prevention of Thromboembolic Events in Surgical Patients Through the Creation and Implementation of a Computerized Risk Assessment Program. J Vasc Surg. 2010;51(3):648-54. PubMed PMID: 20022209.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program. AU - Novis,Sarah Jane, AU - Havelka,George E, AU - Ostrowski,Denise, AU - Levin,Betsy, AU - Blum-Eisa,Laurie, AU - Prystowsky,Jay B, AU - Kibbe,Melina R, PY - 2009/07/21/received PY - 2009/08/31/revised PY - 2009/08/31/accepted PY - 2009/12/22/entrez PY - 2009/12/22/pubmed PY - 2010/4/14/medline SP - 648 EP - 54 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 51 IS - 3 N2 - OBJECTIVES: Deep vein thrombosis (DVT) is a major source of postoperative morbidity and mortality and is currently a major quality improvement initiative. Mechanical and pharmacological prophylaxis is effective in preventing postoperative thromboembolic events, yet it remains underutilized in the clinical setting. Thus, the objective of this study was to develop and implement a computerized DVT risk assessment program in the electronic medical record and determine its effect on compliance with DVT prophylaxis guidelines. METHODS: A standardized DVT risk assessment program was developed and incorporated into the Computerized Patient Record System for all surgical patients at the Jesse Brown Veterans Affairs Medical Center. Four hundred consecutive surgical patients before and after implementation were evaluated for DVT risk, the prescription of pharmacological and mechanical DVT prophylaxis, and the development of thromboembolic events. RESULTS: With implementation of the DVT risk assessment program, the number of patients receiving the recommended pharmacological prophylaxis preoperatively more than doubled (14% to 36%) (P < .001), and use of sequential compression devices (SCD) increased 40% (P < .001). Overall, the percentage of at-risk patients receiving the recommended combined DVT prophylaxis of SCD and pharmacological prophylaxis increased nearly seven-fold (5% to 32%) (P < .001). The assessment also improved use of prophylaxis postoperatively, increasing SCD use by 27% (P < .001). With respect to DVT occurrence, there was an 80% decrease in the incidence of postoperative DVT at 30 days and a 36% decrease at 90 days; however, this did not reach statistical significance due to the low event rate. CONCLUSIONS: The creation and implementation of a standardized DVT risk assessment program in the electronic medical record significantly increased use of pharmacological and mechanical DVT prophylaxis before surgery in a Veterans Affairs Medical Center setting. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/20022209/Prevention_of_thromboembolic_events_in_surgical_patients_through_the_creation_and_implementation_of_a_computerized_risk_assessment_program_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(09)01832-1 DB - PRIME DP - Unbound Medicine ER -