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Sustained Reduction of Postoperative Venous Thromboembolism and Hospital Costs with Electronic Clinical Decision Support Program
John R Hoch*, Anne E Rose*, Abhik Bhattacharya*, Glen E Leverson*, Philip J Trapskin*, Jon S Matsumura*, William D Turnipseed
University of Wisconsin, Madison, WI

OBJECTIVE: We implemented and analyzed a hospital-wide physician and pharmacist-led electronic clinical decision support program designed to improve venous thromboembolism (VTE) prophylaxis and decrease the incidence of VTE.
METHODS: A physician and pharmacist-led interdisciplinary VTE task force was created in 2009 to establish a mandatory electronic medical record (EMR) program for thrombotic risk assessment and selection of evidence-based VTE prophylaxis. Key components of the program are pharmacist-led clinical decision support and monitoring of prescribed therapy and physician education. The EMR was adopted in 2009; order sets were modified in 2010 to include the program and clinical decision support. EMR data was prospectively collected from 2008-11 for type and appropriateness of prophylaxis, postoperative VTE and costs. Rates were compared with chi-square.
RESULTS: See Table. From 2008 to 2011 the rate of postoperative VTE decreased by 66%. Postoperative VTE events decreased in 2009 with the adoption of the EMR but further sustained decreases occurred in 2010 and 2011 with implementation of the full program. VTE reduction corresponded with improved use of prophylaxis. Compared to 2008, this program led to cost savings of \,098,245 for 2009 and \,823 for 2010.
CONCLUSIONS: This system-based program for mandatory EMR-based VTE risk assessment, evidence-based prophylaxis guidelines, and decision support by pharmacy, has led to sustained improvement in VTE prophylaxis, significant reduction in the incidence of postoperative VTE, and dramatic cost savings.
YearVTE Rate per 1000 DischargesNo ProphylaxisDual Mechanical and Pharmaceutical ProphylaxisPreventable VTE
*9 mo dataP<.0001p<.0001P<.0001P<.045

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