Impact of electronic reminders on venous thromboprophylaxis after admissions and transfers

Beeler, Patrick E.; Eschmann, Emmanuel; Schumacher, Autumn; Jd, Studt; Amann-Vesti, Beatrice; Blaser, Jürg

doi:10.1136/amiajnl-2013-002225

Cited by 20 publications

(28 citation statements)

References 36 publications

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“…We attribute the higher rate of major bleeding among those patients for whom chemoprophylaxis was withheld to the hospitalists (appropriately) refraining from prescribing chemoprophylaxis to patients that were at an increased risk for bleeding. The overall rate of HIT we observed was low and analogous to previously reported rates by others and ourselves . While a nonsignificant decrease in HIT was observed, no organized program to mitigate HIT risk occurred during the study.…”

Section: Discussionsupporting

confidence: 86%

Electronic alerts, comparative practitioner metrics, and education improve thromboprophylaxis and reduce venous thrombosis in community hospitals

Woller

Stevens

Evans

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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BackgroundVenous thromboembolism prophylaxis remains underutilized in hospitalized medical patients at high risk for venous thromboembolism. We previously reported that a multifaceted intervention was associated with a sustained increase in appropriate thromboprophylaxis and reduced symptomatic venous thromboembolism among medical patients hospitalized in two urban teaching hospitals. The effectiveness of this intervention in community hospitals is unknown.MethodsWe performed a prospective multicenter cohort study in three community hospitals. All medical patients admitted from February 1, 2011 to January 31, 2014 were eligible. Consecutive eligible patients were enrolled into the 12‐month “control,” 12‐month “intervention,” or 12‐month “maintenance” group. We provided electronic alerts, physician performance feedback, and targeted medical education for the intervention group. Only the alert component of the intervention continued in the maintenance group. The primary outcome was the rate of appropriate thromboprophylaxis among patients at high risk for venous thromboembolism defined as the prescription of guideline recommended chemoprophylaxis, or identification of a chemoprophylaxis contraindication. Secondary outcomes included rates of symptomatic venous thromboembolism, major bleeding, all‐cause mortality, heparin‐induced thrombocytopenia, physician satisfaction, and alert fatigue.ResultsAppropriate thromboprophylaxis when compared to the control group rate of 67% was higher for the intervention group (85%) and for the maintenance group (77%; P < .001 for each comparison). A reduction of 90‐day symptomatic venous thromboembolism accompanied the intervention (control 4.5%, intervention 3.4%, maintenance 3.0%, P = .04).ConclusionsThis multifaceted intervention was associated with an overall increase in appropriate thromboprophylaxis of medical patients compared with the control period. Hospital‐associated venous thrombosis rates decreased.

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Section: Discussionsupporting

confidence: 86%

Electronic alerts, comparative practitioner metrics, and education improve thromboprophylaxis and reduce venous thrombosis in community hospitals

Woller

Stevens

Evans

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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“…[47,56]. The system's userfriendliness and low running CDSS cost resulted in system efficiency in the care delivery process [12,14,15,20].…”

Section: Discussionmentioning

confidence: 99%

“…For patients admitted to hospital, the level of venous thromboembolism prophylaxis and the proportion of prescribed prophylaxis increased from six to 24 hours after admission for clinicians allocated to venous thromboembolism reminder CDSS [12]. In another study, differences among physicians over the thromboprophylaxis treatment effect decreased with the help of CDSS providing treatment recommendation (p-value=0.02) [13].…”

Section: The Effect Of Cdss On Cardiovascular Diseasesmentioning

confidence: 97%

“…The effect of CDSS was measured using different methods in included studies. In most cases, the effect of these programs on physicians' performance and patient outcomes was positive and in others was ineffective.The results show that the use of CDSSs in cardiovascular patients has positive effects on physicians' performance through increasing the prescription of anticoagulants, anti-inflammatory drugs, antithrombotic drugs, lipid-lowering drugs, blood pressure drugs, cardiovascular drugs recommended for the reduction of cardiovascular diseases in patients with diabetes, observing clinical guidelines and improving the quality of patients[12,14,15,20]. The results of the current study are consistent with the results of Brokel et al and Duke et al in reducing inadequate prescriptions and enhancing the process of observing clinical guidelines in the positive effect of CDSS…”

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confidence: 99%

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The effects of clinical decision support system for prescribing on patient outcomes and physician practice performance: A systematic review

Moghadam¹,

Velayati²,

Sadoughi³

et al. 2020

Preprint

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Background The clinical decision support systems(CDSSs) for prescription medications is one of the technologies aimed at improving physician practice behavior and patient outcomes by reducing drug prescription errors. This study was conducted to investigate the effect of various CDSSs on physician practice behavior and patient outcomes.Methods This systematic review was conducted by searching in PubMed, EMBASE, Web of Science, Scopus and Cochrane Library from January 2005 to November 2019. Two researchers independently evaluated the studies. Any discrepancies over the eligibility of the studies between the two researchers were then resolved by consulting a third researcher. Finally, data were extracted from the articles; however, we could not able to conduct meta-analysis due to the heterogeneity of the studies and the narrative form of the findings.Results Based on the inclusion criteria, 46 studies were considered eligible for the analysis in this review. The CDSS for prescription medications had been used for various diseases, namely cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, mental disease. Meanwhile, other cases such as the concurrent prescription of multiple drugs for the patient and its effects on the above-mentioned outcomes were evaluated. The analysis shows that in some cases the application of CDSS provides positive effects on patient outcomes and physician practice behaviors. No significant difference was observed in comparison between some other cases and conventional methods. We think that this could be due to the disease type, the quantity and type of CDSS requirements that influence the comparison.Conclusions Our findings suggest that the positive effects of the CDSS are due to factors such as user-friendliness, compliance with clinical guidelines, patient and doctor cooperation, integration of electronic health records, CDSS and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts and their real-time alerts in the prescription.Registration number on PROSPERO CRD42018079936.

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“…Reminders, warnings and alerts each appeared as a non-interruptive red bar in the top section of the EHR (a screenshot of a similar CDS notification bar has been published elsewhere [21]). By clicking on this bar, a pop-up window was displayed that notified the provider of the reason for the intervention, the prescribed potassium-increasing DDI, the most recent serum potassium value, the creatinine and the glomerular filtration rate, and it also included suggestions how to proceed.…”

Section: The Algorithm Displaying Electronic Notificationsmentioning

confidence: 99%

Negligible impact of highly patient-specific decision support for potassium-increasing drug-drug interactions – a cluster-randomised controlled trial

et al. 2019

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BACKGROUND AND OBJECTIVE: Clinical decision support (CDS) might improve management of potassium-increasing drug-drug interactions (DDI). We studied CDS with five features intended to increase effectiveness: (i) focus on serious DDIs, (ii) fewer notifications, (iii) presentation of current laboratory results, (iv) timing (when adverse event becomes likelier), (v) removal of notification when appropriate.

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Impact of electronic reminders on venous thromboprophylaxis after admissions and transfers

Abstract: 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.

Cited by 20 publications

References 36 publications

Electronic alerts, comparative practitioner metrics, and education improve thromboprophylaxis and reduce venous thrombosis in community hospitals

Electronic alerts, comparative practitioner metrics, and education improve thromboprophylaxis and reduce venous thrombosis in community hospitals

The effects of clinical decision support system for prescribing on patient outcomes and physician practice performance: A systematic review

Negligible impact of highly patient-specific decision support for potassium-increasing drug-drug interactions – a cluster-randomised controlled trial

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