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Electronic alert system for improving appropriate thromboprophylaxis in hospitalized medical patients: a randomized controlled trial
Author(s) -
Spirk D.,
Stuck A. K.,
Hager A.,
Engelberger R. P.,
Aujesky D.,
Kucher N.
Publication year - 2017
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13812
Subject(s) - medicine , interquartile range , venous thromboembolism , randomized controlled trial , clinical endpoint , emergency medicine , chart , medical record , pediatrics , medical emergency , surgery , thrombosis , mathematics , statistics
Essentials Venous thromboembolism (VTE) prophylaxis in hospitalized medical patients remains inconsistent. We implemented an electronic alert system featuring a validated risk assessment model for VTE. In this randomized controlled study, the e‐alert system did not improve VTE prophylaxis. Many electronic alerts were ignored by ordering physicians.Summary Background The use of thromboprophylaxis among acutely ill hospitalized medical patients remains inconsistent. Objective To improve thromboprophylaxis use by implementing a computer‐based alert system combined with a Geneva Risk Score calculation tool in the electronic patient chart and order entry system. Patients/Methods Consecutive patients admitted to the general internal medicine wards of the University Hospital Bern, Switzerland were randomized to the alert group, in which an alert and the Geneva Risk Score calculation tool was issued in the electronic patient chart, or to the control group, in which no alert was issued. The primary endpoint was the rate of appropriate thromboprophylaxis during hospital stay. Results Overall, 1593 patients (alert group, 804; control group, 789) were eligible for analysis. The median age was 67 years (interquartile range, 53–79 years) and 47% were female. Appropriate thromboprophylaxis was administered to 536 (66.7%) patients from the alert group and to 526 (66.7%) patients from the control group. Among the 804 patients from the alert group, a total of 446 (55.5%) either had no score calculation by the physician in charge ( n = 348) or had a calculated score result that was inconsistent with information from the patient chart ( n = 98). Appropriate thromboprophylaxis was less often administered to patients with no score or an inconsistent score result than to 358 patients with a consistent score result (62.6% versus 71.8%). Conclusions The electronic alert (e‐alert) system did not improve appropriate thromboprophylaxis, most likely because many e‐alerts were ignored by ordering physicians. The use of appropriate thromboprophylaxis in the control group was higher than expected.