Nossa Senhora da Conceição Hospital and Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil.
J Bras Pneumol. 2013 Mar-Apr;39(2):138-46. doi: 10.1590/s1806-37132013000200004.
To determine the impact that implementing a combination of a computer-based clinical decision support system and a program of training seminars has on the use of appropriate prophylaxis for venous thromboembolism (VTE).
We conducted a cross-sectional study in two phases (prior to and after the implementation of the new VTE prophylaxis protocol) in order to evaluate the impact that the combined strategy had on the use of appropriate VTE prophylaxis. The study was conducted at Nossa Senhora da Conceição Hospital, a general hospital in the city of Porto Alegre, Brazil. We included clinical and surgical patients over 18 years of age who were hospitalized for > 48 h. The pre-implementation and post-implementation phase samples comprised 262 and 261 patients, respectively.
The baseline characteristics of the two samples were similar, including the distribution of patients by risk level. Comparing the pre-implementation and post-implementation periods, we found that the overall use of appropriate VTE prophylaxis increased from 46.2% to 57.9% (p = 0.01). Looking at specific patient populations, we observed that the use of appropriate VTE prophylaxis increased more dramatically among cancer patients (from 18.1% to 44.1%; p = 0.002) and among patients with three or more risk factors (from 25.0% to 42.9%; p = 0.008), two populations that benefit most from prophylaxis.
It is possible to increase the use of appropriate VTE prophylaxis in economically constrained settings through the use of a computerized protocol adhered to by trained professionals. The underutilization of prophylaxis continues to be a major problem, indicative of the need for ongoing improvement in the quality of inpatient care.
确定实施基于计算机的临床决策支持系统和培训研讨会计划相结合对静脉血栓栓塞症（VTE）预防的适当性的影响。
我们进行了一项两阶段的横断面研究（在实施新的 VTE 预防方案之前和之后），以评估联合策略对适当的 VTE 预防的使用的影响。该研究在巴西阿雷格里港的一家综合医院——Nossa Senhora da Conceição 医院进行。我们纳入了年龄超过 18 岁、住院时间超过 48 小时的临床和手术患者。在实施前和实施后阶段，分别纳入了 262 名和 261 名患者。
两个样本的基线特征相似，包括按风险水平分布的患者。比较实施前和实施后两个阶段，我们发现整体适当的 VTE 预防使用率从 46.2%增加到 57.9%（p = 0.01）。观察特定患者人群，我们发现癌症患者（从 18.1%增加到 44.1%；p = 0.002）和具有 3 个或更多危险因素的患者（从 25.0%增加到 42.9%；p = 0.008）的适当 VTE 预防使用率增加更为显著，这两个群体最受益于预防。
在经济受限的情况下，通过使用计算机化方案并由受过培训的专业人员遵守，可以增加适当的 VTE 预防的使用。预防措施的未充分利用仍然是一个主要问题，表明需要持续改进住院患者的护理质量。
