Research Center for Medical Informatics, University Hospital Zurich, Zurich, Switzerland.
Division of Angiology, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland.
J Am Med Inform Assoc. 2014 Oct;21(e2):e297-303. doi: 10.1136/amiajnl-2013-002225. Epub 2014 Mar 26.
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.
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.
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.
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.
临床决策支持有可能改善静脉血栓栓塞症（VTE）的预防。本前瞻性研究的目的是分析电子提醒对入院和转科病房的预防治疗率的影响。由于患者交接被认为是关键的安全问题，因此后者尤其值得关注。
该试验涉及一家大学医院的六个科室的两个研究期，其中三个科室在第二期被随机分配到显示提醒的干预组。在入院或转科后 6 小时，算法会检查患者到达后 0-30 小时内的预防治疗医嘱，以提高显示提醒的特异性。
可以看到提醒对入院后 6-24 小时内的预防治疗医嘱的显著影响（从 8.6%（223/2579）增加到 12%（307/2555）；p<0.0001）和转科（从 2.4%（39/1616）增加到 3.7%（63/1682）；p=0.034）。入院病房的预防治疗率从 62.4%增加到 67.7%（p<0.0001），转科病房从 80.2%增加到 84.3%（p=0.0022）。总体而言，干预组的预防治疗率从 69.2%增加到 74.3%（p<0.0001），而对照组则没有显著变化。将预防治疗检查推迟到入院和转科后 6 小时，将提醒数量减少了 62%，从而最大限度地降低了警报疲劳的风险。
提醒提高了入院和转科病房对 VTE 预防的认识。这种方法可能有助于提高护理质量和更安全的患者交接。
