Document Detail

Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program.
MedLine Citation:
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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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  51     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Mar 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  648-54     Citation Subset:  IM    
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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MeSH Terms
Aged, 80 and over
Decision Support Systems, Clinical*
Drug Utilization
Early Ambulation / utilization
Electronic Health Records*
Fibrinolytic Agents / therapeutic use
Guideline Adherence
Hospitals, Veterans
Intermittent Pneumatic Compression Devices / utilization
Middle Aged
Physician's Practice Patterns*
Practice Guidelines as Topic
Prospective Studies
Reminder Systems*
Retrospective Studies
Risk Assessment
Risk Factors
Surgical Procedures, Operative / adverse effects*
Thromboembolism / etiology,  prevention & control*
Venous Thrombosis / etiology,  prevention & control*
Young Adult
Reg. No./Substance:
0/Fibrinolytic Agents

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