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Electronic alert system for improving appropriate thromboprophylaxis in hospitalized medical patients: a randomized controlled trial.
J Thromb Haemost. 2017 Aug 24;:
Authors: Spirk D, Stuck AK, Hager A, Engelberger RP, Aujesky D, Kucher N
Abstract
BACKGROUND: The use of thromboprophylaxis among acutely ill hospitalized medical patients remains inconsistent.
OBJECTIVE: We aimed 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 medical 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 (804 alert group, 789 control group) were eligible for analysis. Median age was 67 (53-79) years and 47% were female. Appropriate thromboprophylaxis was administered in 536 (66.7%) patients from the alert group and 526 (66.7%) 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 in patients with no score or inconsistent score result compared to 358 patients with consistent score result (62.6% vs. 71.8%).
CONCLUSIONS: The 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. This article is protected by copyright. All rights reserved.
PMID: 28836340 [PubMed - as supplied by publisher]