A clinical decision support system for venous thromboembolism prophylaxis at a general hospital in a middle-income country

Abstract

OBJECTIVE: To determine the impact that implementing a combination of a computer-based clinical decision support system and a program of training seminars has on the use of appropriate prophylaxis for venous thromboembolism (VTE). METHODS: We conducted a cross-sectional study in two phases (prior to and after the implementation of the new VTE prophylaxis protocol) in order to evaluate the impact that the combined strategy had on the use of appropriate VTE prophylaxis. The study was conducted at Nossa Senhora da Conceição Hospital, a general hospital in the city of Porto Alegre, Brazil. We included clinical and surgical patients over 18 years of age who were hospitalized for ≥ 48 h. The pre-implementation and post-implementation phase samples comprised 262 and 261 patients, respectively. RESULTS: The baseline characteristics of the two samples were similar, including the distribution of patients by risk level. Comparing the pre-implementation and post-implementation periods, we found that the overall use of appropriate VTE prophylaxis increased from 46.2% to 57.9% (p = 0.01). Looking at specific patient populations, we observed that the use of appropriate VTE prophylaxis increased more dramatically among cancer patients (from 18.1% to 44.1%; p = 0.002) and among patients with three or more risk factors (from 25.0% to 42.9%; p = 0.008), two populations that benefit most from prophylaxis. CONCLUSIONS: It is possible to increase the use of appropriate VTE prophylaxis in economically constrained settings through the use of a computerized protocol adhered to by trained professionals. The underutilization of prophylaxis continues to be a major problem, indicative of the need for ongoing improvement in the quality of inpatient care.

Myocardial revascularization: factors intervening in the reference and counter-reference in the hospital setting

“…Regarding the problems mentioned, SUS emergency and emergency services are becoming overwhelmed, facing problems such as the insufficient supply of hospital beds, which ends up prolonging the hospitalization of patients, promoting the aggravation of emergency situations and resulting in greater morbidity and mortality, and sequelae for the user (26)(27)(28) , requiring greater investments in infrastructure and public policies that prevent the patient from seeking services of high complexity due to the worsening clinical conditions of the disease.…”

O que mudou nas últimas décadas na profilaxia do tromboembolismo venoso em pacientes internados: artigo de revisão

“…Adequacy of prophylaxis increased from 46.2% to 57.9% in the before and after comparison between the two periods, and the increases were greatest among patients with cancer (18.1% to 44.1%) and those with three or more risk factors (25% to 42.9%). 71 Despite the many initiatives and the increased use of VTE risk assessment, prophylaxis is still being underutilized today and there is also evidence of low compliance with published guidelines. 72,73 Lau & Haut conducted a MEDLINE search to identify studies published from 2001 to 2012 that evaluated the different types of interventions designed to improve use of VTE prophylaxis in hospitalized patients, classified according to the following parameters: exclusively educational, paper-based, computerized, real time auditing, or a combination of interventions.…”

Venous thromboembolism in Latin America: a review and guide to diagnosis and treatment for primary care

“…Clear guidance and education on how comorbidities may affect therapy might increase healthcare providers' adherence to existing guidelines 23 - 25 . Pilot studies using programs and guidance protocols to facilitate treatment decisions in Brazil and Argentina have demonstrated improvements in the level of appropriate anticoagulation administered to patients with or at risk of VTE 26 , 27 . The aim of this review is to outline an algorithmic approach for primary care providers in Latin America for VTE diagnosis in ambulatory patients and to discuss current and emerging options for the treatment of these patients.…”

“…Consequently, ambulatory patients who would be suitable for outpatient treatment with new oral anticoagulants may be admitted to the hospital to receive the first few days of treatment as inpatients. In some institutions, patients may be admitted to receive unfractionated heparin via continuous infusion pump to avoid the high cost of LMWH 13 , 26 , despite the greater overall cost to the healthcare system of doing so 74 , 75 . Thus, while it may be theoretically possible for 80% of patients with DVT to be managed on an outpatient basis 76 , 77 , the actual rate of outpatient care is much lower and both institutional and healthcare system costs are increased.…”