P E Beeler1, E Eschmann1, A Schumacher2, J-D Studt3, B Amann-Vesti4, J Blaser1. 1. Research Center for Medical Informatics, University Hospital Zurich, Zurich, Switzerland. 2. Division of Angiology, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland. 3. Division of Hematology, University Hospital Zurich, Zurich, Switzerland. 4. Division of Angiology, University Hospital Zurich, Zurich, Switzerland.
Abstract
OBJECTIVE: Clinical decision support has the potential to improve prevention of venous thromboembolism (VTE). The purpose of this prospective study was to analyze the effect of electronic reminders on thromboprophylaxis rates in wards to which patients were admitted and transferred. The latter was of particular interest since patient handoffs are considered to be critical safety issues. METHODS: The trial involved two study periods in the six departments of a university hospital, three of which were randomly assigned to the intervention group displaying reminders during the second period. At 6 h after admission or transfer, the algorithm checked for prophylaxis orders within 0-30 h of the patient's arrival, increasing the specificity of the displayed reminders. RESULTS: The significant impact of the reminders could be seen by prophylaxis orders placed 6-24 h after admission (increasing from 8.6% (223/2579) to 12% (307/2555); p<0.0001) and transfer (increasing from 2.4% (39/1616) to 3.7% (63/1682); p=0.034). In admission wards, the rate of thromboprophylaxis increased from 62.4% to 67.7% (p<0.0001), and in transfer wards it increased from 80.2% to 84.3% (p=0.0022). Overall, the rate of prophylaxis significantly increased in the intervention group from 69.2% to 74.3% (p<0.0001). No significant changes were observed in the control group. Postponing prophylaxis checks to 6 h after admissions and transfers reduced the number of reminders by 62% and thereby minimized the risk of alert fatigue. CONCLUSIONS: The reminders improved awareness of VTE prevention in both admission and transfer wards. This approach may contribute to better quality of care and safer patient handoffs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
RCT Entities:
OBJECTIVE: Clinical decision support has the potential to improve prevention of venous thromboembolism (VTE). The purpose of this prospective study was to analyze the effect of electronic reminders on thromboprophylaxis rates in wards to which patients were admitted and transferred. The latter was of particular interest since patient handoffs are considered to be critical safety issues. METHODS: The trial involved two study periods in the six departments of a university hospital, three of which were randomly assigned to the intervention group displaying reminders during the second period. At 6 h after admission or transfer, the algorithm checked for prophylaxis orders within 0-30 h of the patient's arrival, increasing the specificity of the displayed reminders. RESULTS: The significant impact of the reminders could be seen by prophylaxis orders placed 6-24 h after admission (increasing from 8.6% (223/2579) to 12% (307/2555); p<0.0001) and transfer (increasing from 2.4% (39/1616) to 3.7% (63/1682); p=0.034). In admission wards, the rate of thromboprophylaxis increased from 62.4% to 67.7% (p<0.0001), and in transfer wards it increased from 80.2% to 84.3% (p=0.0022). Overall, the rate of prophylaxis significantly increased in the intervention group from 69.2% to 74.3% (p<0.0001). No significant changes were observed in the control group. Postponing prophylaxis checks to 6 h after admissions and transfers reduced the number of reminders by 62% and thereby minimized the risk of alert fatigue. CONCLUSIONS: The reminders improved awareness of VTE prevention in both admission and transfer wards. This approach may contribute to better quality of care and safer patient handoffs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: P Chopard; J Dörffler-Melly; U Hess; W A Wuillemin; D Hayoz; A Gallino; E B Bachli; C R Canova; J Isenegger; R Rubino; H Bounameaux Journal: J Intern Med Date: 2005-04 Impact factor: 8.989
Authors: Erik G Van Eaton; Karen D Horvath; William B Lober; Anthony J Rossini; Carlos A Pellegrini Journal: J Am Coll Surg Date: 2005-04 Impact factor: 6.113
Authors: Caprice C Greenberg; Scott E Regenbogen; David M Studdert; Stuart R Lipsitz; Selwyn O Rogers; Michael J Zinner; Atul A Gawande Journal: J Am Coll Surg Date: 2007-04 Impact factor: 6.113
Authors: Nils Kucher; Sophia Koo; Rene Quiroz; Joshua M Cooper; Marilyn D Paterno; Boris Soukonnikov; Samuel Z Goldhaber Journal: N Engl J Med Date: 2005-03-10 Impact factor: 91.245
Authors: Kaveh G Shojania; Alison Jennings; Alain Mayhew; Craig R Ramsay; Martin P Eccles; Jeremy Grimshaw Journal: Cochrane Database Syst Rev Date: 2009-07-08
Authors: Janice L Kwan; Lisha Lo; Jacob Ferguson; Hanna Goldberg; Juan Pablo Diaz-Martinez; George Tomlinson; Jeremy M Grimshaw; Kaveh G Shojania Journal: BMJ Date: 2020-09-17
Authors: Scott C Woller; Scott M Stevens; R Scott Evans; Daniel Wray; John Christensen; Valerie T Aston; Matthew Wayne; James F Lloyd; Emily L Wilson; C Gregory Elliott Journal: Res Pract Thromb Haemost Date: 2018-06-07