Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
J Vasc Surg. 2010 Mar;51(3):648-54. doi: 10.1016/j.jvs.2009.08.097.
Deep vein thrombosis (DVT) is a major source of postoperative morbidity and mortality and is currently a major quality improvement initiative. Mechanical and pharmacological prophylaxis is effective in preventing postoperative thromboembolic events, yet it remains underutilized in the clinical setting. Thus, the objective of this study was to develop and implement a computerized DVT risk assessment program in the electronic medical record and determine its effect on compliance with DVT prophylaxis guidelines.
A standardized DVT risk assessment program was developed and incorporated into the Computerized Patient Record System for all surgical patients at the Jesse Brown Veterans Affairs Medical Center. Four hundred consecutive surgical patients before and after implementation were evaluated for DVT risk, the prescription of pharmacological and mechanical DVT prophylaxis, and the development of thromboembolic events.
With implementation of the DVT risk assessment program, the number of patients receiving the recommended pharmacological prophylaxis preoperatively more than doubled (14% to 36%) (P < .001), and use of sequential compression devices (SCD) increased 40% (P < .001). Overall, the percentage of at-risk patients receiving the recommended combined DVT prophylaxis of SCD and pharmacological prophylaxis increased nearly seven-fold (5% to 32%) (P < .001). The assessment also improved use of prophylaxis postoperatively, increasing SCD use by 27% (P < .001). With respect to DVT occurrence, there was an 80% decrease in the incidence of postoperative DVT at 30 days and a 36% decrease at 90 days; however, this did not reach statistical significance due to the low event rate.
The creation and implementation of a standardized DVT risk assessment program in the electronic medical record significantly increased use of pharmacological and mechanical DVT prophylaxis before surgery in a Veterans Affairs Medical Center setting.
深静脉血栓形成（DVT）是术后发病率和死亡率的主要原因，目前是一项主要的质量改进措施。机械和药物预防措施可有效预防术后血栓栓塞事件，但在临床实践中仍未得到充分利用。因此，本研究的目的是开发和实施电子病历中的计算机化 DVT 风险评估程序，并确定其对 DVT 预防指南依从性的影响。
为杰西布朗退伍军人事务医疗中心的所有手术患者开发并实施了一种标准化的 DVT 风险评估程序，并将其纳入计算机患者记录系统。在实施前后，评估了 400 例连续手术患者的 DVT 风险、药物和机械 DVT 预防措施的处方以及血栓栓塞事件的发生情况。
实施 DVT 风险评估程序后，术前接受推荐药物预防治疗的患者数量增加了一倍以上（从 14%增加到 36%）（P<0.001），序贯压迫装置（SCD）的使用率增加了 40%（P<0.001）。总体而言，接受推荐的 SCD 和药物联合预防治疗的高危患者比例增加了近七倍（从 5%增加到 32%）（P<0.001）。评估还改善了术后预防治疗的使用，SCD 的使用增加了 27%（P<0.001）。关于 DVT 的发生，术后 30 天和 90 天的 DVT 发生率分别降低了 80%和 36%；然而，由于发生率较低，这并没有达到统计学意义。
在退伍军人事务医疗中心环境中，在电子病历中创建和实施标准化 DVT 风险评估程序显著增加了手术前药物和机械 DVT 预防的使用。
