Development and implementation of venous thromboembolism stewardship across a hospital network.

Cross-Sectional Studies Hospitalization Hospitals Humans Risk Assessment Venous Thromboembolism / drug therapy
Decision support systems, clinical Pharmacists Quality improvement Risk assessment Venous thromboembolism

Journal

International journal of medical informatics
ISSN: 1872-8243
Titre abrégé: Int J Med Inform
Pays: Ireland
ID NLM: 9711057

Informations de publication

Date de publication:
11 2021
Historique:
received: 29 05 2021
revised: 21 08 2021
accepted: 09 09 2021
pubmed: 25 9 2021
medline: 25 2 2023
entrez: 24 9 2021
Statut: ppublish

Résumé

Venous thromboembolism (VTE) is a leading cause of preventable death in hospital. Ensuring all hospitalized patients are assessed for VTE risk and given appropriate prophylaxis can reduce the burden of VTE on patients and the healthcare system. This is the first study to explore the effectiveness of a VTE stewardship program using electronic clinical decision support (eCDS) to provide oversight of hospital initiatives to prevent VTE. To determine if a VTE stewardship program can increase risk-appropriate VTE prophylaxis, VTE risk assessment using eCDS, any documented risk assessment and risk assessment within 24 h of admission, plus reduce the incidence of hospital acquired VTE (HA-VTE). Education, daily medication chart auditing, weekly clinician performance feedback, health promotion and gamification were deployed over 6 months by two multidisciplinary VTE stewardship teams across four hospitals. Service impact was assessed through cross-sectional audits of electronic medical records every 3 months and review of HA-VTE events pre- and post-intervention. Implementation costs were calculated. A total of 1622 patients were audited in separate cohorts at baseline, 3, 6 and 9 months. There was significant improvement in the prescription of appropriate prophylaxis (78%, 83%, 84%, and 88%, p = 0.004), VTE risk assessment using the eCDS tool (20%, 50%, 81% and 87%, p < 0.001), any documented risk assessment (71%, 82%, 95% and 93%, p < 0.001) and any documented risk assessment within 24 h of admission (54%, 56%, 65% and 63%, p = 0.001). Use of eCDS was associated with prescription of risk-appropriate VTE prophylaxis (p < 0.001). Annual incidence of HA-VTE decreased from 7.88 to 6.99 events per 10,000 discharges pre- to post-intervention (Odds Ratio (OR) 0.89, 95 %CI 0.66-1.18, p = 0.43). The cost of implementing the program across 133,078 episodes of care during the study period was AUD$108,167 (mean cost of $0.82 per patient).

Sections du résumé

BACKGROUND
Venous thromboembolism (VTE) is a leading cause of preventable death in hospital. Ensuring all hospitalized patients are assessed for VTE risk and given appropriate prophylaxis can reduce the burden of VTE on patients and the healthcare system. This is the first study to explore the effectiveness of a VTE stewardship program using electronic clinical decision support (eCDS) to provide oversight of hospital initiatives to prevent VTE.
AIM
To determine if a VTE stewardship program can increase risk-appropriate VTE prophylaxis, VTE risk assessment using eCDS, any documented risk assessment and risk assessment within 24 h of admission, plus reduce the incidence of hospital acquired VTE (HA-VTE).
METHODS
Education, daily medication chart auditing, weekly clinician performance feedback, health promotion and gamification were deployed over 6 months by two multidisciplinary VTE stewardship teams across four hospitals. Service impact was assessed through cross-sectional audits of electronic medical records every 3 months and review of HA-VTE events pre- and post-intervention. Implementation costs were calculated.
RESULTS
A total of 1622 patients were audited in separate cohorts at baseline, 3, 6 and 9 months. There was significant improvement in the prescription of appropriate prophylaxis (78%, 83%, 84%, and 88%, p = 0.004), VTE risk assessment using the eCDS tool (20%, 50%, 81% and 87%, p < 0.001), any documented risk assessment (71%, 82%, 95% and 93%, p < 0.001) and any documented risk assessment within 24 h of admission (54%, 56%, 65% and 63%, p = 0.001). Use of eCDS was associated with prescription of risk-appropriate VTE prophylaxis (p < 0.001). Annual incidence of HA-VTE decreased from 7.88 to 6.99 events per 10,000 discharges pre- to post-intervention (Odds Ratio (OR) 0.89, 95 %CI 0.66-1.18, p = 0.43). The cost of implementing the program across 133,078 episodes of care during the study period was AUD$108,167 (mean cost of $0.82 per patient).

Identifiants

DOI: 10.1016/j.ijmedinf.2021.104575 PMID: 34560489
pubmed: 34560489
pii: S1386-5056(21)00201-X
doi: 10.1016/j.ijmedinf.2021.104575
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

104575

Informations de copyright

Copyright © 2021 Elsevier B.V. All rights reserved.

Auteurs

Julianne Chong (J)

Concord Repatriation General Hospital, Pharmacy Department, Sydney, Australia. Electronic address: julianne.chong@health.nsw.gov.au.

Colin Curtain (C)

University of Tasmania, School of Pharmacy and Pharmacology, Hobart, Australia.

Fady Gad (F)

Royal Prince Alfred Hospital, Pharmacy Department, Sydney, Australia.

Freda Passam (F)

Royal Prince Alfred Hospital, Department of Hematology, Sydney, Australia.

Garry Soo (G)

Concord Repatriation General Hospital, Pharmacy Department, Sydney, Australia.

Russell Levy (R)

Royal Prince Alfred Hospital, Pharmacy Department, Sydney, Australia.

Scott Dunkley (S)

Royal Prince Alfred Hospital, Department of Hematology, Sydney, Australia.

Nicole Wong Doo (N)

Concord Repatriation General Hospital, Department of Hematology, Sydney, Australia; University of Sydney, Concord Clinical School, Sydney, Australia.

Michelle Cunich (M)

University of Sydney, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), Sydney, Australia; Sydney Local Health District, Sydney Health Economics Collaborative, Sydney, Australia.

Rosemary Burke (R)

Executive Unit, Sydney Local Health District, Sydney, Australia.

Vivien Chen (V)

Concord Repatriation General Hospital, Department of Hematology, Sydney, Australia; Anzac Research Institute, Concord, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia.

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Classifications MeSH

questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études transversales › Development and implementation of venous...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Development and implementation of venous...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Development and implementation of venous...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Development and implementation of venous...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Appréciation des risques › Development and implementation of venous...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Thromboembolie › Thromboembolisme veineux › Development and implementation of venous...