J Am Med Inform Assoc - Impact of electronic reminders on venous thromboprophylaxis after admissions and transfers.

Tópicos

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Resumo

JECTIVE: 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 6 h after admission or transfer, the algorithm checked for prophylaxis orders within 0-30 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 6-24 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 6 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.

Resumo Limpo

jectiv clinic decis support potenti improv prevent venous thromboembol vte purpos prospect studi analyz effect electron remind thromboprophylaxi rate ward patient admit transfer latter particular interest sinc patient handoff consid critic safeti issuesmethod trial involv two studi period six depart univers hospit three random assign intervent group display remind second period h admiss transfer algorithm check prophylaxi order within h patient arriv increas specif display remindersresult signific impact remind seen prophylaxi order place h admiss increas p transfer increas p admiss ward rate thromboprophylaxi increas p transfer ward increas p overal rate prophylaxi signific increas intervent group p signific chang observ control group postpon prophylaxi check h admiss transfer reduc number remind therebi minim risk alert fatigueconclus remind improv awar vte prevent admiss transfer ward approach may contribut better qualiti care safer patient handoff

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