Venous thromboembolism (VTE) is frequently under‐ or overtreated in hospitals. Thus, regulators are encouraging hospitals to invest in systematic approaches to better manage anticoagulation. Here, we describe an initiative to implement VTE treatment best practices through computerized decision support (CDS), and measure its impact.
We integrated content from locally adapted national guidelines into a CDS intervention and implemented it across the 3 hospitals in our health system. On entering terms related to VTE treatment into the computer physician order entry (CPOE), the CDS would provide order sets for anticoagulant dosing based on patient weight. In addition, if IV heparin (UFH) was selected, follow‐up CBC and PT/PTT would be ordered. The CDS also featured soft stops for enoxaparin based on low GFRs calculated from a patient's last Cr and extremes of weight. Study subjects included all adults admitted to the 3 hospitals in our health system in the 6 months before and after the CDS was launched (February 2009). Process measures included percentage of patients treated for VTE who were therapeutic at 24 and 46 hours, that same measure just in patients treated with UFH, and percentage of encounters with critically high PTTs. Outcome measures included hospilal‐associated bleeding, defined as encounters with secondary discharge diagnostic codes consistent with bleeding as well as E codes specific for drug‐induced adverse events. We also measured the utilization of the CDS. Data were extracted from administrative and clinical databases. The study was IRB approved.
There were minimal differences in the characteristics of the study population before and after the CDS. Overall, there was a nonsignificant increase in therapeutic anticoagulation at 24 hours, which approached statistical significance at 48 hours [520 (76.5%) vs. 534 (80.5%), P = 0.07]. When patients treated with UFH were examined at 24 hours, there was a statistically significant increase in therapeutic anticoagulation at 1 hospital [65 (33.7%) vs. 75 (40.3%), P = 0.04], but insignificant increases in the other 2. Increases remained statistically insignif cant at 48 hours. There was a statistically significant decrease in critically high PTTs in those treated for VTE [257 (37.8%) vs. 200 (30.2%), P < 0.01] and an insignificant decrease in bleeds. Only 27% of the VTE treatment orders were placed through the CDS.
The CDS resulted in an increase in patients with VTE who were therapeutic within 24 hours of treatment initiation, but this increase was only statistically significant at 1 of 3 hospitals studied. The CDS resulted in a significant decrease in patients with critically high PTTs, but no impact on bleeds. The marginal impact of the CDS likely resulted from its infrequent use compared with alternative methods of ordering anticoagulation.
C. Umscheid, none; A. Hanish, none; J. Chittams, none; T. Hecht, none; S. Sood, none; C. Kean, none; M. Massary, none; C. Smith, none; M. Weiner, none.
To cite this abstract:Umscheid C, Hanish A, Chittams J, Hecht T, Sood S, Kean C, Massary M, Smith C, Weiner M. Impact of a Computerized Decision Support on Venous Thromboembolism Treatment in the Inpatient Setting. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 147. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/impact-of-a-computerized-decision-support-on-venous-thromboembolism-treatment-in-the-inpatient-setting/. Accessed November 13, 2019.