Initiative to reduce inappropriate venous thromboembolism prophylaxis in an 11‐hospital safety net system: An electronic health records‐based approach

Abstract

Background While pharmacologic prophylaxis has benefits for venous thromboembolism (VTE) prevention in high‐risk patients, unnecessary use carries potential harm, including bleeding, heparin‐induced thrombocytopenia, and patient discomfort, and should be avoided in low‐risk patients. While many quality improvement initiatives aim to reduce underuse, successful models on reducing overuse are sparse in the literature. Objective We aimed to create a quality improvement initiative to reduce overuse of pharmacologic VTE prophylaxis. Designs, Settings and Participants A quality improvement initiative was implemented across 11 safety net hospitals in New York City. Intervention The first electronic health record (EHR) intervention consisted of a VTE order panel that facilitated risk assessment and recommended VTE prophylaxis for high‐risk patients only. The second EHR intervention used a best practice advisory that alerted clinicians when prophylaxis was ordered for a patient previously deemed “low risk.” Prescribing rates were compared through a three‐segment interrupted time series linear regression design. Results Compared to the preintervention period, the first intervention did not change the rate of total pharmacologic prophylaxis immediately after implementation (1.7% relative change, p = .38) or over time (slope difference of 0.20 orders per 1000 patient days, p = .08). Compared to the first intervention period, the second intervention led to an immediate 4.5% reduction in total pharmacologic prophylaxis (p = .04) but increased thereafter (slope difference of 0.24, p = .03) such that weekly rates at the end of the study were similar to rates prior to the second intervention.