RT Journal
A1 Haut ER, Lau BD, Kraenzlin FS, et al
T1 IMproved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical decision support tool for prophylaxis for venous thromboembolism in trauma
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD October 1
VO 147
IS 10
SP 901
OP 907
DO 10.1001/archsurg.2012.2024
UL http://dx.doi.org/10.1001/archsurg.2012.2024
AB Objective 
                  Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry–based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry–based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients.Design 
                  Retrospective cohort study (from January 2007 through December 2010).Setting 
                  University-based, state-designated level 1 adult trauma center.Patients 
                  A total of 1599 hospitalized adult trauma patients with a hospital length of stay greater than 1 day.Main Outcome Measures 
                  The primary outcome measure was the proportion of patients who were ordered risk-appropriate guideline-suggested VTE prophylaxis. The secondary outcome measure was the proportion of patients with any preventable VTE (defined as VTE in a patient not ordered guideline-appropriate VTE prophylaxis), pulmonary embolism, and/or deep vein thrombosis.Results 
                  Compliance with guideline-appropriate prophylaxis increased from 66.2% to 84.4% (P < .001). The rate of preventable harm from VTE decreased from 1.0% to 0.17% (P = .04).Conclusions 
                  Implementation of a mandatory computerized provider order entry–based clinical decision support tool significantly improved compliance with VTE prophylaxis guidelines in hospitalized adult trauma patients. This improved compliance was associated with a significant decrease in the rate of preventable harm, which was defined as VTE events in patients not ordered appropriate prophylaxis.