Key result
Electronic alert systems linked to a ~21% absolute increase in pharmacologic VTE prophylaxis rates.
Why the study?
Pharmacologic VTE prophylaxis rates in hospitalized IBD patients are suboptimal, and the impact of electronic alert systems on these rates has not been studied.
Does an electronic alert system improve pharmacologic VTE prophylaxis rates in hospitalized IBD patients?
Cohort (n=576)
Does an electronic alert system improve pharmacologic VTE prophylaxis rates in hospitalized IBD patients?
Implementation of an electronic alert system significantly increases the rates of pharmacologic VTE prophylaxis orders in hospitalized IBD patients, though patient refusal remains a barrier to administration.
Answers are grounded in this paper and cite their sources.
Electronic alerts may boost VTE prophylaxis; leaves open impact on clinical events and requires prospective validation.
BACKGROUND: Utilization of pharmacologic venous thromboembolism (VTE) prophylaxis in inflammatory bowel disease (IBD) patients seems to be suboptimal with reported rates as low as 50% in some studies. Implementation of an electronic alert system seems to be an effective tool for increasing VTE prophylaxis rates in medical inpatients. To date, no studies have assessed whether this approach is associated with improved rates of pharmacologic VTE prophylaxis specifically in IBD patients. AIMS: To determine the efficacy of an electronic alert in improving VTE prophylaxis rates in hospitalized IBD patients. METHODS: We conducted a retrospective cohort study of 576 hospitalized IBD patients. The medical record of each patient was then examined to determine whether pharmacologic VTE prophylaxis was both ordered and administered, the timing of pharmacologic VTE prophylaxis, and reasons for any missed doses. RESULTS: The VTE pharmacologic prophylaxis rate was improved from 60% to 81.2% following the implementation of the electronic alert system (p < .001). An increase in prophylaxis rates was seen in both medical (26.3% vs. 62.8%, p < .001) and surgical services (83.7% vs. 95.5%, p < .001). In patients who received pharmacologic VTE prophylaxis, 16% of all ordered doses were not administered and 57.3% of missed doses were the result of patient refusal. Hospitalization after implementation of the electronic alert system (odds ratio [OR] 4.71, 95% confidence interval [CI] 2.94-7.57) and admission to a surgical service (OR 14.3, 95% CI 8.62-24.39) were predictive of VTE pharmacologic prophylaxis orders. CONCLUSIONS: The introduction of an electronic alert system was associated with a significant increase in rates of pharmacologic VTE prophylaxis. However, orders were often delayed and doses not always administered. The most common reason that ordered doses were not given was patient refusal.
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Mathers et al. (2016) conducted a cohort in Inflammatory bowel disease (n=576). Electronic alert system vs. Pre-implementation was evaluated on Pharmacologic VTE prophylaxis rate (OR 4.71, 95% CI 2.94-7.57, p=<.001). Implementation of an electronic alert system was associated with an increase in pharmacologic VTE prophylaxis rates from 60% to 81.2%.
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