An Electronic Alert System is Associated with a Significant Increase in Pharmacologic Venous Thromboembolism Prophylaxis Rates among Hospitalized Inflammatory Bowel Disease Patients

Bradley Mathers, Emmanuelle Williams, Gurneet Bedi, Evangelos Messaris, Andrew Tinsley

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Utilization of pharmacologic venous thromboembolism (VTE) prophylaxis in inflammatory bowel disease (IBD) patients seems to be suboptimal with reported rates as low as 50% in some studies. Implementation of an electronic alert system seems to be an effective tool for increasing VTE prophylaxis rates in medical inpatients. To date, no studies have assessed whether this approach is associated with improved rates of pharmacologic VTE prophylaxis specifically in IBD patients. Aims: To determine the efficacy of an electronic alert in improving VTE prophylaxis rates in hospitalized IBD patients. Methods: We conducted a retrospective cohort study of 576 hospitalized IBD patients. The medical record of each patient was then examined to determine whether pharmacologic VTE prophylaxis was both ordered and administered, the timing of pharmacologic VTE prophylaxis, and reasons for any missed doses. Results: The VTE pharmacologic prophylaxis rate was improved from 60% to 81.2% following the implementation of the electronic alert system (p <.001). An increase in prophylaxis rates was seen in both medical (26.3% vs. 62.8%, p <.001) and surgical services (83.7% vs. 95.5%, p <.001). In patients who received pharmacologic VTE prophylaxis, 16% of all ordered doses were not administered and 57.3% of missed doses were the result of patient refusal. Hospitalization after implementation of the electronic alert system (odds ratio [OR] 4.71, 95% confidence interval [CI] 2.94-7.57) and admission to a surgical service (OR 14.3, 95% CI 8.62-24.39) were predictive of VTE pharmacologic prophylaxis orders. Conclusions: The introduction of an electronic alert system was associated with a significant increase in rates of pharmacologic VTE prophylaxis. However, orders were often delayed and doses not always administered. The most common reason that ordered doses were not given was patient refusal.

Original languageEnglish (US)
Pages (from-to)307-314
Number of pages8
JournalJournal for Healthcare Quality
Volume39
Issue number5
DOIs
StatePublished - Jan 1 2017

Fingerprint

Venous Thromboembolism
Inflammatory Bowel Diseases
Odds Ratio
Confidence Intervals
Medical Records
Inpatients
Hospitalization
Cohort Studies
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

@article{67b3cf37fd6c4e42b70bd183f932bb89,
title = "An Electronic Alert System is Associated with a Significant Increase in Pharmacologic Venous Thromboembolism Prophylaxis Rates among Hospitalized Inflammatory Bowel Disease Patients",
abstract = "Background: Utilization of pharmacologic venous thromboembolism (VTE) prophylaxis in inflammatory bowel disease (IBD) patients seems to be suboptimal with reported rates as low as 50{\%} in some studies. Implementation of an electronic alert system seems to be an effective tool for increasing VTE prophylaxis rates in medical inpatients. To date, no studies have assessed whether this approach is associated with improved rates of pharmacologic VTE prophylaxis specifically in IBD patients. Aims: To determine the efficacy of an electronic alert in improving VTE prophylaxis rates in hospitalized IBD patients. Methods: We conducted a retrospective cohort study of 576 hospitalized IBD patients. The medical record of each patient was then examined to determine whether pharmacologic VTE prophylaxis was both ordered and administered, the timing of pharmacologic VTE prophylaxis, and reasons for any missed doses. Results: The VTE pharmacologic prophylaxis rate was improved from 60{\%} to 81.2{\%} following the implementation of the electronic alert system (p <.001). An increase in prophylaxis rates was seen in both medical (26.3{\%} vs. 62.8{\%}, p <.001) and surgical services (83.7{\%} vs. 95.5{\%}, p <.001). In patients who received pharmacologic VTE prophylaxis, 16{\%} of all ordered doses were not administered and 57.3{\%} of missed doses were the result of patient refusal. Hospitalization after implementation of the electronic alert system (odds ratio [OR] 4.71, 95{\%} confidence interval [CI] 2.94-7.57) and admission to a surgical service (OR 14.3, 95{\%} CI 8.62-24.39) were predictive of VTE pharmacologic prophylaxis orders. Conclusions: The introduction of an electronic alert system was associated with a significant increase in rates of pharmacologic VTE prophylaxis. However, orders were often delayed and doses not always administered. The most common reason that ordered doses were not given was patient refusal.",
author = "Bradley Mathers and Emmanuelle Williams and Gurneet Bedi and Evangelos Messaris and Andrew Tinsley",
year = "2017",
month = "1",
day = "1",
doi = "10.1097/JHQ.0000000000000021",
language = "English (US)",
volume = "39",
pages = "307--314",
journal = "Journal for healthcare quality : official publication of the National Association for Healthcare Quality",
issn = "1062-2551",
publisher = "National Association for Healthcare Quality",
number = "5",

}

TY - JOUR

T1 - An Electronic Alert System is Associated with a Significant Increase in Pharmacologic Venous Thromboembolism Prophylaxis Rates among Hospitalized Inflammatory Bowel Disease Patients

AU - Mathers, Bradley

AU - Williams, Emmanuelle

AU - Bedi, Gurneet

AU - Messaris, Evangelos

AU - Tinsley, Andrew

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: Utilization of pharmacologic venous thromboembolism (VTE) prophylaxis in inflammatory bowel disease (IBD) patients seems to be suboptimal with reported rates as low as 50% in some studies. Implementation of an electronic alert system seems to be an effective tool for increasing VTE prophylaxis rates in medical inpatients. To date, no studies have assessed whether this approach is associated with improved rates of pharmacologic VTE prophylaxis specifically in IBD patients. Aims: To determine the efficacy of an electronic alert in improving VTE prophylaxis rates in hospitalized IBD patients. Methods: We conducted a retrospective cohort study of 576 hospitalized IBD patients. The medical record of each patient was then examined to determine whether pharmacologic VTE prophylaxis was both ordered and administered, the timing of pharmacologic VTE prophylaxis, and reasons for any missed doses. Results: The VTE pharmacologic prophylaxis rate was improved from 60% to 81.2% following the implementation of the electronic alert system (p <.001). An increase in prophylaxis rates was seen in both medical (26.3% vs. 62.8%, p <.001) and surgical services (83.7% vs. 95.5%, p <.001). In patients who received pharmacologic VTE prophylaxis, 16% of all ordered doses were not administered and 57.3% of missed doses were the result of patient refusal. Hospitalization after implementation of the electronic alert system (odds ratio [OR] 4.71, 95% confidence interval [CI] 2.94-7.57) and admission to a surgical service (OR 14.3, 95% CI 8.62-24.39) were predictive of VTE pharmacologic prophylaxis orders. Conclusions: The introduction of an electronic alert system was associated with a significant increase in rates of pharmacologic VTE prophylaxis. However, orders were often delayed and doses not always administered. The most common reason that ordered doses were not given was patient refusal.

AB - Background: Utilization of pharmacologic venous thromboembolism (VTE) prophylaxis in inflammatory bowel disease (IBD) patients seems to be suboptimal with reported rates as low as 50% in some studies. Implementation of an electronic alert system seems to be an effective tool for increasing VTE prophylaxis rates in medical inpatients. To date, no studies have assessed whether this approach is associated with improved rates of pharmacologic VTE prophylaxis specifically in IBD patients. Aims: To determine the efficacy of an electronic alert in improving VTE prophylaxis rates in hospitalized IBD patients. Methods: We conducted a retrospective cohort study of 576 hospitalized IBD patients. The medical record of each patient was then examined to determine whether pharmacologic VTE prophylaxis was both ordered and administered, the timing of pharmacologic VTE prophylaxis, and reasons for any missed doses. Results: The VTE pharmacologic prophylaxis rate was improved from 60% to 81.2% following the implementation of the electronic alert system (p <.001). An increase in prophylaxis rates was seen in both medical (26.3% vs. 62.8%, p <.001) and surgical services (83.7% vs. 95.5%, p <.001). In patients who received pharmacologic VTE prophylaxis, 16% of all ordered doses were not administered and 57.3% of missed doses were the result of patient refusal. Hospitalization after implementation of the electronic alert system (odds ratio [OR] 4.71, 95% confidence interval [CI] 2.94-7.57) and admission to a surgical service (OR 14.3, 95% CI 8.62-24.39) were predictive of VTE pharmacologic prophylaxis orders. Conclusions: The introduction of an electronic alert system was associated with a significant increase in rates of pharmacologic VTE prophylaxis. However, orders were often delayed and doses not always administered. The most common reason that ordered doses were not given was patient refusal.

UR - http://www.scopus.com/inward/record.url?scp=85032195216&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032195216&partnerID=8YFLogxK

U2 - 10.1097/JHQ.0000000000000021

DO - 10.1097/JHQ.0000000000000021

M3 - Article

VL - 39

SP - 307

EP - 314

JO - Journal for healthcare quality : official publication of the National Association for Healthcare Quality

JF - Journal for healthcare quality : official publication of the National Association for Healthcare Quality

SN - 1062-2551

IS - 5

ER -