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(Chest. 2004;125:1635-1641.)
© 2004 American College of Chest Physicians

The Effect of a Computerized Reminder System on the Prevention of Postoperative Venous Thromboembolism*

David Mosen, PhD, MPH; C. Gregory Elliott, MD, FCCP; Marlene J. Egger, PhD; Michael Mundorff, MBA; James Hopkins, MD; Robert Patterson, MD, MSc and Reed M. Gardner, PhD

* From the Department of Public Health & Preventive Medicine (Dr. Mosen), Oregon Health & Science University, Portland, OR; the Pulmonary/Critical Care Division (Drs. Elliot and Hopkins), LDS Hospital, Salt Lake City, UT; the Department of Family and Preventive Medicine (Dr. Egger), and Medical Informatics (Drs. Patterson and Gardner), University of Utah School of Medicine, Salt Lake City, UT; and Institute for Health Care Delivery Research (Mr. Mundorff), Intermountain Health Care, Salt Lake City, UT.

Correspondence to: C. Gregory Elliott, MD, FCCP, Pulmonary Division, LDS Hospital, Eighth Ave and C St, Salt Lake City, UT 84143; e-mail: ldgellio{at}ihc.com

Study objective: To measure the effect of an altered process of care, directed by a computerized reminder system, on rates of symptomatic postoperative venous thromboembolism.

Design: Comparisons of preintervention and postintervention measurements.

Setting: A university-affiliated community hospital in Utah.

Patients: Two-thousand seventy-seven consecutive patients who underwent major operations in four surgical divisions between January 1, 1997, and October 31, 1997 (preintervention), and 2,093 consecutive patients who underwent the same procedures between January 1, 1998, and October 31,1998 (postintervention).

Intervention: A program to prevent venous thromboembolism developed from American College of Chest Physicians guidelines, and an altered work process directed by a computerized reminder system.

Measurements: Rates of symptomatic, objectively confirmed deep vein thrombosis (DVT), pulmonary embolism (PE), and death attributable to venous thromboembolism occurring within 90 days of the date of surgery.

Results: The preintervention and postintervention cohorts did not differ with respect to age, severity of illness, number of risk factors for venous thromboembolism, or individual risk factors for venous thromboembolism. The overall prophylaxis rate increased from 89.9% before implementation of the computerized reminder system to 95.0% after implementation (p < 0.0001). The combined 90-day rate of symptomatic DVT, PE, and death attributable to PE remained the same (preintervention, 1.0%; postintervention, 1.2%; odds ratio, 1.21; 95% confidence interval, 0.67 to 2.20). Forty of 46 venous thromboembolic complications (87%) occurred despite the delivery of American College of Chest Physicians-recommended measures to prevent venous thromboembolism.

Conclusions: Computerized reminder systems combined with altered care procedures increase the rate of prophylaxis against venous thromboembolism without decreasing the rate of symptomatic venous thromboembolism when the baseline rate of prophylaxis is high. A population of surgical patients exists who are resistant to American College of Chest Physicians-recommended prophylactic measures against venous thromboembolism. New strategies are needed to address prophylaxis-resistant venous thromboembolism.

Key Words: computer reminders • deep vein thrombosis • prevention • prophylaxis • pulmonary embolism






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