Key result
Integration of a clinical decision-support tool into the electronic health record significantly decreased unwarranted VTE prophylaxis from 59.5% to 35.7% and increased use of the preferred pharmacologic agent.
Why the study?
Adherence to guideline-based venous thromboembolism prophylaxis recommendations is often inadequate, and effective improvement strategies are needed.
Does an EHR-integrated clinical decision-support tool improve adherence to guideline-based VTE prophylaxis recommendations in acutely ill medical patients?
Cross-Sectional (n=194)
No
Does an EHR-integrated clinical decision-support tool improve adherence to guideline-based VTE prophylaxis recommendations in acutely ill medical patients?
Absolute Event Rate: 35.7% vs 59.5%
p-value: p=0.02
Integrating a clinical decision-support tool into the EHR significantly improves adherence to guideline-based VTE prophylaxis in acutely ill medical patients.
Supports EHR integration of VTE decision-support tools; extends evidence for reducing overuse in practice.
Background: Adherence to guideline-based venous thromboembolism (VTE) prophylaxis recommendations is often inadequate. Effective improvement strategies are needed. Objective: The purpose of this quality improvement initiative was to increase use of the facility’s preferred pharmacologic VTE prophylaxis, reduce unnecessary VTE prophylaxis use, and reduce use of pharmacologic VTE prophylaxis in high bleeding risk patients, in accordance with guideline-based recommendations. Methods: Clinical pharmacists spearheaded the development and implementation of a clinical decision-support tool (CDST) integrated within a Veterans Health Administration electronic health record (EHR). The CDST focused on VTE prophylaxis in acutely ill medical patients and guided prescribers to guideline-based recommendations. Following review and approval, the CDST underwent activation in the EHR. A subsequent intervention occurred, year 2 post-intervention, which embedded this CDST into the EHR admission process and admission menus. A drug message was added in the EHR to alert prescribers that low-molecular-weight heparin was the preferred agent. Measures were evaluated pre-intervention, year 1 post-intervention, and year 2 post-intervention. Results: After intervention, there were statistically significant increases in the proportion of patients receiving the facility’s preferred pharmacologic VTE prophylaxis agent, enoxaparin, and a statistically significant decrease in the proportion of unwarranted VTE prophylaxis. The proportion of inappropriate pharmacologic VTE prophylaxis in high bleeding risk patients decreased, but this result did not reach statistical significance. Conclusion: The improvements observed suggest the beneficial role of CDSTs integrated into the EHR to increase adherence to guideline-based VTE prophylaxis recommendations.
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George et al. (2020) conducted a cross-sectional in Risk for venous thromboembolism in acutely ill medical patients (n=194). Clinical decision-support tool (CDST) integrated within the EHR vs. Pre-intervention period (standard care without CDST) was evaluated on Proportion of unwarranted VTE prophylaxis (p=0.02). Integration of a clinical decision-support tool into the electronic health record significantly decreased unwarranted VTE prophylaxis from 59.5% to 35.7% and increased use of the preferred pharmacologic agent.
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