Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.
Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.
Int J Qual Health Care. 2021 Mar 22;33(1). doi: 10.1093/intqhc/mzab034.
Venous thromboembolism (VTE) is an important patient safety concern. VTE leads to significant mortality and morbidity and a burden on healthcare resources. Despite the widespread availability of evidence-based clinical practice guidelines on VTE prophylaxis, we found that only 50.9% of our patients were receiving appropriate prophylaxis. The purpose of this study was to evaluate the impact of automation of an adapted VTE prophylaxis CPG using a clinical decision support system (the VTE-CDSS) on VTE prevention among hospitalised adult patients.
A quasi-experimental study (pre- and post-implementation) was conducted at a large 900-bed tertiary teaching multi-specialty hospital in Riyadh, Saudi Arabia.
The 1809 adult patients in the study included 871 enrolled during the pre-implementation stage and 938 enrolled during the post-implementation stage.
Multi-faceted implementation interventions were utilised, including leadership engagement and support, quality and clinical champions, staff training and education and regular audit and feedback.
Two rate-based process measures were calculated for each admission cohort (i.e. pre- and post-implementation): the percentage of inpatients who were assessed for VTE risk on admission and the percentage of inpatients who received appropriate VTE prophylaxis. Two outcome measures were calculated: the prevalence of hospital-acquired VTE (HA-VTE) events and the in-hospital all-cause mortality.
The percentage of inpatients risk assessed for VTE on admission increased from 77.4% to 93.3% (P < 0.01). The percentage of patients who received appropriate VTE prophylaxis increased from 50.9% to 81.4% (P < 0.01). The HA-VTE events decreased by 50% from 0.33% to 0.15% (P < 0.01).All-cause in-hospital mortality did not significantly change after implementation of the VTE-CDSS compared with pre-implementation mortality (P > 0.05).
The VTE-CDSS improved patient safety by enhancing adherence to the VTE prophylaxis best practice and adapted CPG. The multi-faceted implementation strategies approach improved the compliance rate of risk assessment and the adherence to prophylaxis recommendations and substantially reduced the HA-VTE prevalence. A successful CDSS requires a set of critical components to ensure better user compliance and positive patient outcomes.
静脉血栓栓塞症（VTE）是一个重要的患者安全问题。VTE 会导致显著的死亡率和发病率，并给医疗资源带来负担。尽管有广泛的基于证据的 VTE 预防临床实践指南，但我们发现只有 50.9%的患者接受了适当的预防。本研究的目的是评估使用临床决策支持系统（VTE-CDSS）自动化改编的 VTE 预防临床实践指南对住院成年患者 VTE 预防的影响。
在沙特阿拉伯利雅得的一家大型 900 床三级教学多专科医院进行了一项准实验研究（实施前和实施后）。
该研究包括 1809 名成年患者，其中 871 名在实施前阶段登记，938 名在实施后阶段登记。
采用了多方面的实施干预措施，包括领导力参与和支持、质量和临床冠军、员工培训和教育以及定期审核和反馈。
为每个入院队列计算了两个基于率的过程测量值（即实施前和实施后）：入院时评估 VTE 风险的住院患者百分比和接受适当 VTE 预防的住院患者百分比。计算了两个结果测量值：医院获得性 VTE（HA-VTE）事件的发生率和院内全因死亡率。
入院时评估 VTE 风险的住院患者百分比从 77.4%增加到 93.3%（P<0.01）。接受适当 VTE 预防的患者百分比从 50.9%增加到 81.4%（P<0.01）。HA-VTE 事件的发生率从 0.33%下降到 0.15%（P<0.01）。与实施 VTE-CDSS 前的死亡率相比，实施后全因院内死亡率没有显著变化（P>0.05）。
VTE-CDSS 通过增强对 VTE 预防最佳实践和改编 CPG 的依从性来提高患者安全性。多方面的实施策略提高了风险评估和预防建议的依从性，并大大降低了 HA-VTE 的发生率。成功的 CDSS 需要一组关键组件，以确保更好的用户依从性和积极的患者结果。
