An Electronic Medical Record Intervention to Increase Pharmacologic Prophylaxis for Venous Thromboembolism in Emergency Department Observation Patients - 15/12/23
, Rebecca E. Cash, PhD c, David Meguerdichian, MD a, Lisette Dunham, MPS, MSPH b, Timothy Stump, BS b, Ronelle Stevens, PharmD d, Audrey Reust, PA-C a, Benjamin White, MD c, Sayon Dutta, MD, MPH b, cAbstract |
Study objective |
The role of venous thromboembolism (VTE) prophylaxis among patients receiving emergency department (ED) observation unit care is unclear. We investigated an electronic health record-based clinical decision support tool aimed at increasing pharmacologic VTE prophylaxis use among at-risk patients placed in ED observation units.
Methods |
We conducted an interrupted time-series study of an Epic-based best practice advisory implemented in May 2019 at a health care system comprising 2 academic medical centers and 4 community hospitals with dedicated ED observation units. The best practice advisory alerted staff at 24 hours to conduct a risk assessment and linked to a VTE prophylaxis order set. We used an interrupted time series, Bayesian structured time series, and a multivariable mixed-effect regression model to estimate the intervention effect.
Results |
Prior to the best practice advisory implementation, there were 8,895 ED observation unit patients with a length of stay more than or equal to 24 hours, and 0.9% received pharmacologic VTE prophylaxis. Afterward, there were 12,664 ED observation unit patients with a length of stay more than or equal to 24 hours, and 4.8% received pharmacologic VTE prophylaxis. The interrupted time series and causal impact analysis showed a statistically significant increase in VTE prophylaxis (eg, absolute percent difference 3.8%, 95% confidence interval 3.5 to 4.1). In a multivariable model, only the intervention was significantly associated with receiving VTE prophylaxis (odds ratio 4.56, 95% confidence interval 2.22 to 9.37).
Conclusion |
An electronic health record-based alert helped to prompt staff caring for ED observation unit patients at risk for VTE with prolonged visits to order recommended pharmacologic prophylaxis. The best risk assessment model to use and the true incidence of VTE events in this population are unclear.
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| Please see page 25 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Tyler W. Barrett, MD, MSCI. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: CWB conceived the study and CWB served as lead author. REC and SD performed the statistical analysis under the supervision of CWB. CWB drafted the manuscript, and all authors contributed substantially to its revision. CWB takes responsibility for the paper as a whole. |
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| Data sharing statement: Data is not shareable per IRB. SQL queries and analytic code for this investigation are available upon request, from the date of article publication by contacting Sayon Dutta, MD, at sdutta1@mgb.org. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors report this article did not receive any outside funding or support. The authors have declared that no competing interests exist. |
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Vol 83 - N° 1
P. 24-34 - janvier 2024 Retour au numéro
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