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Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program.

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.

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  • Authors+Show Affiliations

    ,

    Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.

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    Source

    Journal of vascular surgery 51:3 2010 Mar pg 648-54

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Algorithms
    Automation
    Decision Support Systems, Clinical
    Drug Utilization
    Early Ambulation
    Electronic Health Records
    Female
    Fibrinolytic Agents
    Guideline Adherence
    Hospitals, Veterans
    Humans
    Illinois
    Intermittent Pneumatic Compression Devices
    Male
    Middle Aged
    Practice Guidelines as Topic
    Practice Patterns, Physicians'
    Prospective Studies
    Reminder Systems
    Retrospective Studies
    Risk Assessment
    Risk Factors
    Surgical Procedures, Operative
    Thromboembolism
    Venous Thrombosis
    Young Adult

    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 -