Institute of Pharmacology, University of Bern, Bern, Switzerland.
Swiss Cardiovascular Center, Division of Vascular Medicine, University of Bern, University Hospital Bern, Bern, Switzerland.
J Thromb Haemost. 2017 Nov;15(11):2138-2146. doi: 10.1111/jth.13812. Epub 2017 Sep 20.
Essentials Venous thromboembolism (VTE) prophylaxis in hospitalized medical patients remains inconsistent. We implemented an electronic alert system featuring a validated risk assessment model for VTE. In this randomized controlled study, the e-alert system did not improve VTE prophylaxis. Many electronic alerts were ignored by ordering physicians.
Background The use of thromboprophylaxis among acutely ill hospitalized medical patients remains inconsistent. Objective To improve thromboprophylaxis use by implementing a computer-based alert system combined with a Geneva Risk Score calculation tool in the electronic patient chart and order entry system. Patients/Methods Consecutive patients admitted to the general internal medicine wards of the University Hospital Bern, Switzerland were randomized to the alert group, in which an alert and the Geneva Risk Score calculation tool was issued in the electronic patient chart, or to the control group, in which no alert was issued. The primary endpoint was the rate of appropriate thromboprophylaxis during hospital stay. Results Overall, 1593 patients (alert group, 804; control group, 789) were eligible for analysis. The median age was 67 years (interquartile range, 53-79 years) and 47% were female. Appropriate thromboprophylaxis was administered to 536 (66.7%) patients from the alert group and to 526 (66.7%) patients from the control group. Among the 804 patients from the alert group, a total of 446 (55.5%) either had no score calculation by the physician in charge (n = 348) or had a calculated score result that was inconsistent with information from the patient chart (n = 98). Appropriate thromboprophylaxis was less often administered to patients with no score or an inconsistent score result than to 358 patients with a consistent score result (62.6% versus 71.8%). Conclusions The electronic alert (e-alert) system did not improve appropriate thromboprophylaxis, most likely because many e-alerts were ignored by ordering physicians. The use of appropriate thromboprophylaxis in the control group was higher than expected.
通过在电子病历和医嘱录入系统中引入基于计算机的警示系统并结合日内瓦风险评分计算工具，改善血栓预防措施的应用。
患者/方法：连续入组瑞士伯尔尼大学附属医院综合内科病房的患者，随机分为警示组和对照组。警示组在电子病历中发出警示和计算日内瓦风险评分，对照组则不发出警示。主要终点是住院期间适当的血栓预防措施的应用率。
共有 1593 例患者（警示组 804 例，对照组 789 例）符合分析条件。中位年龄为 67 岁（四分位间距 53-79 岁），47%为女性。警示组有 536 例（66.7%）患者接受了适当的血栓预防措施，对照组有 526 例（66.7%）患者接受了适当的血栓预防措施。在警示组的 804 例患者中，共有 446 例（55.5%）要么没有主管医生计算评分（n = 348），要么计算的评分结果与患者病历信息不一致（n = 98）。与 358 例评分结果一致的患者相比，无评分或评分结果不一致的患者接受适当血栓预防措施的比例较低（62.6% vs. 71.8%）。
电子警示（e-alert）系统并未改善适当的血栓预防措施，这很可能是因为许多电子警示被医嘱开具医生忽视了。对照组适当血栓预防措施的应用率高于预期。
