Open AccessImplementation of an electronic medical record tool for early detection of deep vein thrombosis in the ambulatory oncology setting
Author(s) -
Kunapareddy Girish,
Switzer Benjamin,
Jain Prantesh,
Conces Madison,
Chen YuWei,
Patel Bhumika,
Patel Sagar,
Pinnamaneni Pramod,
Pohlman Brad,
Angelini Dana E.,
McCrae Keith R.,
Khorana Alok A.
Publication year - 2019
Publication title -
research and practice in thrombosis and haemostasis
Language(s) - English
Resource type - Journals
ISSN - 2475-0379
DOI - 10.1002/rth2.12176
Subject(s) - medicine , deep vein , ambulatory , thrombosis , pulmonary embolism , medical record , electronic medical record , emergency medicine , emergency department , surgery , pediatrics , psychiatry
Background Venous thromboembolism ( VTE ) is a major cause of morbidity, mortality, and hospitalization in cancer patients. Objectives To evaluate the feasibility of an electronic alert to identify and screen at‐risk individuals and gather rates of early detection of deep vein thrombosis ( DVT ). Patients/Methods An alert was built into the electronic medical record based on a validated risk tool (Khorana Score [ KS ]) and outcomes evaluated in an initial silent phase. The alert functioned in real time to warn physicians of high‐risk patients ( KS ≥ 3) and suggested lower extremity screening ultrasonography in a subsequent active phase. Results Of 194 consecutive patients identified as high risk in the silent phase, 14 (7.2%) developed subsequent DVT or pulmonary embolism ( PE ) over 90‐day follow‐up, with a median of 27 days. Mean 90‐day emergency room ( ER ) visits, all‐cause admissions, and length of stay (days) for patients with DVT were 1.2, 1.6, and 9.1 compared to 0.89, 0.93, and 5.1 for all patients, respectively. In the active phase, 197 consecutive alerts met inclusion criteria, and 40 patients (20.3%) received a screening ultrasound. Five (12.5%) had a DVT and were started on therapeutic anticoagulation. Of patients with alerts who had screening deferred, 13 (8.3%) were later diagnosed with DVT (median 50.5 days) and 7 (4.5%) with PE . Conclusion An automated alert may have value in early detection of DVT in high‐risk cancer patients leading to earlier intervention, and could potentially prevent VTE ‐related morbidity.