Electronic alert system for improving appropriate thromboprophylaxis in hospitalized medical patients: a randomized controlled trial.

Spirk, David; Stuck, A K; Hager, A; Engelberger, R P; Aujesky, Drahomir; Kucher, N (2017). Electronic alert system for improving appropriate thromboprophylaxis in hospitalized medical patients: a randomized controlled trial. Journal of thrombosis and haemostasis, 15(11), pp. 2138-2146. Wiley-Blackwell 10.1111/jth.13812

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Essentials Venous thromboembolism (VTE) prophylaxis in hospitalized medical patients remains inconsistent. We implemented an electronic alert system featuring a validated risk assessment model for VTE. In this randomized controlled study, the e-alert system did not improve VTE prophylaxis. Many electronic alerts were ignored by ordering physicians. SUMMARY Background The use of thromboprophylaxis among acutely ill hospitalized medical patients remains inconsistent. Objective To improve thromboprophylaxis use by implementing a computer-based alert system combined with a Geneva Risk Score calculation tool in the electronic patient chart and order entry system. Patients/Methods Consecutive patients admitted to the general internal medicine wards of the University Hospital Bern, Switzerland were randomized to the alert group, in which an alert and the Geneva Risk Score calculation tool was issued in the electronic patient chart, or to the control group, in which no alert was issued. The primary endpoint was the rate of appropriate thromboprophylaxis during hospital stay. Results Overall, 1593 patients (alert group, 804; control group, 789) were eligible for analysis. The median age was 67 years (interquartile range, 53-79 years) and 47% were female. Appropriate thromboprophylaxis was administered to 536 (66.7%) patients from the alert group and to 526 (66.7%) patients from the control group. Among the 804 patients from the alert group, a total of 446 (55.5%) either had no score calculation by the physician in charge (n = 348) or had a calculated score result that was inconsistent with information from the patient chart (n = 98). Appropriate thromboprophylaxis was less often administered to patients with no score or an inconsistent score result than to 358 patients with a consistent score result (62.6% versus 71.8%). Conclusions The electronic alert (e-alert) system did not improve appropriate thromboprophylaxis, most likely because many e-alerts were ignored by ordering physicians. The use of appropriate thromboprophylaxis in the control group was higher than expected.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Pharmacology

UniBE Contributor:

Spirk, David and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1538-7836

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Jana Berger

Date Deposited:

08 Mar 2018 14:39

Last Modified:

18 Jan 2019 08:47

Publisher DOI:

10.1111/jth.13812

PubMed ID:

28836340

Uncontrolled Keywords:

internal medicine medical order entry systems prophylaxis risk assessment venous thromboembolism

BORIS DOI:

10.7892/boris.111506

URI:

https://boris.unibe.ch/id/eprint/111506

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