SummaryDespite current guidelines, venous thromboembolism( VTE) prophylaxis is underused.Computerized programs to encourage physicians to applythromboprophylaxis have been shownto be effectiveinselectedpopulations. Our aim was to analyzethe impacto ft he implementationo fac omputer-alert system for VTE risk in allhospitalized patients of ateachinghospital. Acomputerprogram linked to the clinical recorddatabase was developed to assess allhospitalized patients'VTE risk daily.Thephysician responsible forp atientsa th igh riskw as alerted,but remainedfreetoorder or withholdprophylaxis.Over19,000 hospitalized, medical and surgical, adult patients between Januaryto Thei mplementationo fac omputer-alert program helps physicians to assess each patient's thrombotic risk,leading to abetter use of thromboprophylaxis, and areductioninthe incidence of VTE among hospitalized patients.For thefirsttime,aninterventionaimed to improveVTE prophylaxis showsmaintained effectivenessovertime.
An ImCU led by hospitalists showed encouraging results regarding patient survival and SAPS II is an useful tool for prognostic evaluation in this population. Intermediate care serves as an expansion of role for hospitalists; and clinicians, trainees and patients may benefit from co-management and teaching opportunities at this unique level of care.
Summary. Objectives: The prevention of venous thromboembolism (VTE) is a priority for improved safety in hospitalised patients. Worldwide, there is growing concern over the undersuse of appropriate thromboprophylaxis. Computerised decision support improves the implementation of thromboprophylaxis and reduces inpatient VTE. However, an economic assessment of this approach has not yet been performed. Objectives: To evaluate the economic impact of an electronic alert (e-alert) system to prevent VTE in hospitalised patients over a 4 year period. Patients/methods: All hospitalised patients at a single institution during the first semesters of [2005][2006][2007][2008][2009] (n = 32 280) were included. All cases of VTE developed during hospitalisation were followed and direct costs of diagnosis and management collected. Results: E-alerts achieved a sustained reduction of the incidence of in-hospital VTE, OR 0.50 (95% CI, 0.29-0.84), the impact being especially significant in medical patients, OR 0.44 (95% CI, 0.22-0.86). No increase in prophylaxis-related bleeding was observed. In our setting, the mean direct cost (during hospitalisation and after discharge) of an in-hospital VTE episode is €7058. Direct costs per single hospitalised patient were reduced after e-alerts from €21.6 to €11.8, while the increased use of thromboprophylaxis and the development of e-alerts meant €3 and €0.35 per patient, respectively. Thus, the implementation of e-alerts led to a net cost saving of €6.5 per hospitalised patient. Should all hospitalised patients in Spain be considered, total yearly savings would approach €30 million. Conclusions: E-alerts are useful and cost-effective tools for thromboprophylaxis strategy in hospitalised patients. Fewer thromboembolic complications and lower costs are achieved by its implementation.
We conclude that assessment of changes in diet quality could be a useful tool in predicting body composition changes in obese adolescents involved in a diet and physical activity intervention programme backed-up by psychological and family support.
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