|Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program.|
|PMID: 20022209 Owner: NLM Status: MEDLINE|
|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.
|Sarah Jane Novis; George E Havelka; Denise Ostrowski; Betsy Levin; Laurie Blum-Eisa; Jay B Prystowsky; Melina R Kibbe|
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|Type: Journal Article|
|Title: Journal of vascular surgery Volume: 51 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2010 Mar|
|Created Date: 2010-03-08 Completed Date: 2010-04-13 Revised Date: 2012-10-03|
Medline Journal Info:
|Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States|
|Languages: eng Pagination: 648-54 Citation Subset: IM|
|Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Aged, 80 and over
Decision Support Systems, Clinical*
Early Ambulation / utilization
Electronic Health Records*
Fibrinolytic Agents / therapeutic use
Intermittent Pneumatic Compression Devices / utilization
Physician's Practice Patterns*
Practice Guidelines as Topic
Surgical Procedures, Operative / adverse effects*
Thromboembolism / etiology, prevention & control*
Venous Thrombosis / etiology, prevention & control*
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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