Service of General Internal Medicine, University Hospitals, Geneva, Switzerland.
J Thromb Haemost. 2010 Jun;8(6):1230-4. doi: 10.1111/j.1538-7836.2010.03817.x. Epub 2010 Feb 19.
The adequacy of thromboprophylaxis prescriptions in acutely ill hospitalized medical patients needs improvement.
To prospectively assess the efficacy of thromboprophylaxis adequacy of various clinical decision support systems (CDSS) with the aim of increasing the use of explicit criteria for thromboprophylaxis prescription in nine Swiss medical services.
We randomly assigned medical services to a pocket digital assistant program (PDA), pocket cards (PC) and no CDSS (controls). In centers using an electronic chart, an e-alert system (eAlerts) was developed. After 4 months, we compared post-CDSS with baseline thromboprophylaxis adequacy for the various CDSS and control groups.
Overall, 1085 patients were included (395 controls, 196 PC, 168 PDA, 326 eAlerts), 651 pre- and 434 post-CDSS implementation: 472 (43.5%) presented a risk of VTE justifying thromboprophylaxis (31.8% pre, 61.1% post) and 556 (51.2%) received thromboprophylaxis (54.2% pre, 46.8% post). The overall adequacy (% patients with adequate prescription) of pre- and post-CDSS implementation was 56.2 and 50.7 for controls (P = 0.29), 67.3 and 45.3 for PC (P = 0.002), 66.0 and 64.9 for PDA (P = 0.99), 50.5 and 56.2 for eAlerts (P = 0.37), respectively, eAlerts limited overprescription (56% pre, 31% post, P = 0.01).
While pocket cards and handhelds did not improve thromboprophylaxis adequacy, eAlerts had a modest effect, particularly on the reduction of overprescription. This effect only partially contributes to the improvement of patient safety and more work is needed towards institution-tailored tools.
急性住院内科患者的血栓预防治疗方案的充分性有待提高。
前瞻性评估各种临床决策支持系统（CDSS）的血栓预防治疗方案充分性，目的是增加在瑞士 9 个内科服务中使用明确的血栓预防治疗方案的指征。
我们将内科服务随机分配到掌上数字助理程序（PDA）、掌上卡片（PC）和无 CDSS（对照组）。在使用电子病历的中心，开发了电子警报系统（eAlerts）。在 CDSS 实施后 4 个月，我们比较了各种 CDSS 和对照组的 CDSS 前后的血栓预防治疗方案充分性。
共有 1085 例患者纳入研究（395 例对照组、196 例 PC、168 例 PDA、326 例 eAlerts），分别有 651 例和 434 例患者在 CDSS 实施前后接受了评估：472 例（43.5%）有静脉血栓栓塞风险需要进行血栓预防治疗（实施前为 31.8%，实施后为 61.1%），556 例（51.2%）接受了血栓预防治疗（实施前为 54.2%，实施后为 46.8%）。对照组实施前后的整体充分性（有充分治疗方案的患者比例）分别为 56.2%和 50.7%（P=0.29），PC 组分别为 67.3%和 45.3%（P=0.002），PDA 组分别为 66.0%和 64.9%（P=0.99），eAlerts 组分别为 50.5%和 56.2%（P=0.37），eAlerts 可限制过度治疗（实施前为 56%，实施后为 31%，P=0.01）。
虽然掌上卡片和手持设备没有提高血栓预防治疗方案的充分性，但电子警报系统有一定的效果，特别是在减少过度治疗方面。这种效果仅部分有助于提高患者安全性，还需要针对不同机构的需求来开发工具。
