Impact of a venous thromboembolism prophylaxis “smart order set”: Improved compliance, fewer events

Zeidan, Amer M.; Streiff, Michael B.; Lau, Brandyn; Ahmed, S; Kraus, Peggy S.; Hobson, Deborah B.; Carolan, Howard; Lambrianidi, Chryso; Horn, Paula B.; Shermock, Kenneth M.; Tinoco, Gabriel; Siddiqui, Salahuddin; Haut, Elliott R.

doi:10.1002/ajh.23450

Cited by 91 publications

(68 citation statements)

References 42 publications

(44 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Each arm uses data from previously published cohort studies within the same hospital, 39, 41 employing novel analyses to explore the impact of the intervention on the basis of race and gender.…”

Section: Methodsmentioning

confidence: 99%

“…39 The second arm included all adult patients admitted to the internal medicine service during the month of November 2007 (the month immediately prior to implementation of the CCDS tool) and during the month of April 2010 (the last month prior to data collection for the study). 41 …”

Section: Methodsmentioning

confidence: 99%

“…Compliance with best-practice VTE prophylaxis in both the pre- and post-implementation groups was defined as adherence to our service-specific VTE prevention algorithm. 38, 39, 41 Race and gender were determined based on documentation of patient self-identification collected by administrative personnel during hospitalization.…”

Section: Methodsmentioning

confidence: 99%

“…Using a mandatory CCDS tool, we have previously demonstrated significant improvements in prescription of risk-appropriate VTE prophylaxis and reduction in potentially preventable VTE. 38–41 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Eliminating Health Care Disparities With Mandatory Clinical Decision Support

et al. 2015

Self Cite

View full text Add to dashboard Cite

Background All hospitalized patients should be assessed for VTE risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacologic prophylaxis, and then recommends the risk-appropriate VTE prophylaxis regimen. Objectives To examine the effect of a quality improvement intervention on race- and gender-based healthcare disparities across two distinct clinical services. Research Design Retrospective cohort study of a quality improvement intervention Subjects 1942 hospitalized medical patients and 1599 hospitalized adult trauma patients Measures Proportion of patients prescribed risk-appropriate, best-practice VTE prophylaxis Results Racial disparities existed in prescription of best-practice VTE prophylaxis in the pre-implementation period between black and white patients on both the trauma (70.1% vs. 56.6%, p=0.025) and medicine (69.5% vs. 61.7%, p=0.015) services. After implementation of the CCDS tool, compliance improved for all patients and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5% vs. 85.5%, p=0.99) and medicine (91.8% vs. 88.0%, p=0.082). Similar findings were noted for gender disparities in the trauma cohort. Conclusions Despite the fact that risk-appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and gender, practice varied widely prior to our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across two distinct clinical services. Health information technology approaches to care standardization are effective to eliminate healthcare disparities.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Eliminating Health Care Disparities With Mandatory Clinical Decision Support

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…Using physician responses, the order sets recommended evidence-based, risk-appropriate VTE prophylaxis. To measure the efficacy of the smart order sets, a retrospective chart review was conducted of 1,000 consecutive patients during 1 month immediately prior to (November 2007, n =1,000) and 1 month after (April 2010, n =942) the order set launch 39. The smart order sets significantly improved compliance with prophylaxis recommendations, resulting in significantly fewer VTE events.…”

Section: Venous Thromboembolism Prophylaxis: Missed Opportunitiesmentioning

confidence: 99%

Implementing Thrombosis Guidelines in Cancer Patients: A Review

Farge‐Bancel¹,

Bounameaux²,

Brenner³

et al. 2014

Rambam Maimonides Med J

View full text Add to dashboard Cite

Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients.

show abstract