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JCOM Abstract

J Clin Outcomes Manage 
2011 Nov;18(11):505-512
Venous thromboembolism prophylaxis and the impact of standardized guidelines: is a computer-based approach enough?
Quraishi MB, Mathew R, Lowes A, Bashir CM, Markert RJ

ABSTRACT: Objective: To determine the frequency of venous thromboembolism (VTE) prophylaxis and the incidence of VTE before and after the implementation of computer-based prophylaxis guidelines based on the American College of Chest Physicians (ACCP) recommendations. Methods: Using a retrospective chart review, we stratified 1406 Veterans Affairs Medical Center patients with multiple risk factors into 3 risk categories (high, intermediate, and low) and determined the frequency of VTE prophylaxis and the VTE rate before and after the implementation of ACCP guidelines. Results: Before the guidelines were implemented, appropriate VTE prophylaxis was used in 401 of 701 (57.2%) patients. After implementation, appropriate prophylaxis was used in 549 of 705 (77.9%) (P < 0.001). The frequency of VTE before guideline implementation was 1.4% (10 cases) while after implementation the rate was 1.2% (8 cases) (P = 0.54). Conclusion: The implementation of computer-based guidelines improved VTE prophylaxis. Electronic alerts and physician education regarding VTE prevention are needed to improve physician compliance and the appropriate selection of prophylaxis.

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