Impact of electronic reminders on venous thromboprophylaxis after admissions and transfers.
J Am Med Inform Assoc
; 21(e2): e297-303, 2014 Oct.
Article
em En
| MEDLINE
| ID: mdl-24671361
ABSTRACT
OBJECTIVE:
Clinical decision support has the potential to improve prevention of venous thromboembolism (VTE). The purpose of this prospective study was to analyze the effect of electronic reminders on thromboprophylaxis rates in wards to which patients were admitted and transferred. The latter was of particular interest since patient handoffs are considered to be critical safety issues.METHODS:
The trial involved two study periods in the six departments of a university hospital, three of which were randomly assigned to the intervention group displaying reminders during the second period. At 6â h after admission or transfer, the algorithm checked for prophylaxis orders within 0-30â h of the patient's arrival, increasing the specificity of the displayed reminders.RESULTS:
The significant impact of the reminders could be seen by prophylaxis orders placed 6-24â h after admission (increasing from 8.6% (223/2579) to 12% (307/2555); p<0.0001) and transfer (increasing from 2.4% (39/1616) to 3.7% (63/1682); p=0.034). In admission wards, the rate of thromboprophylaxis increased from 62.4% to 67.7% (p<0.0001), and in transfer wards it increased from 80.2% to 84.3% (p=0.0022). Overall, the rate of prophylaxis significantly increased in the intervention group from 69.2% to 74.3% (p<0.0001). No significant changes were observed in the control group. Postponing prophylaxis checks to 6â h after admissions and transfers reduced the number of reminders by 62% and thereby minimized the risk of alert fatigue.CONCLUSIONS:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Sistemas de Registro de Ordens Médicas
/
Tromboembolia Venosa
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Transferência da Responsabilidade pelo Paciente
/
Anticoagulantes
Tipo de estudo:
Clinical_trials
/
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J Am Med Inform Assoc
Assunto da revista:
INFORMATICA MEDICA
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
Suíça