Venous Thromboembolism
Conditions
Keywords
venous thromboembolism, thromboprophylaxis, anticoagulants, hospitalized medical patients, electronic order sets, decision support, knowledge translation, patient safety
Brief summary
Venous thromboemboli (VTE) are abnormal blood clots that commonly form in the blood vessels of the legs or lungs. They can block normal blood flow, damage organs, and even cause death. The risk of VTE is increased in people who are sick or immobile. VTE is the most common preventable cause of death in hospitalized patients, and its VTE prevention should be a top patient safety priority. Though there is good evidence that injectable blood thinners and/or compression stockings can prevent VTE, over 30% of hospitalized medical patients in Hamilton, Ontario receive inappropriate prevention. Hamilton Health Sciences Corporation is in the process of introducing electronic order sets - computer programs that help doctors order medications and other healthcare interventions for their patients. The investigators would like to study if these electronic order sets can help improve the rate of appropriate VTE prevention in hospitalized medical patients. The investigators will examine the rate before and after the introduction of electronic order sets at the Juravinski Hospital and the Hamilton General Hospital. Doctors at the Hamilton General Hospital will also get to use an additional computer program, called a computerized decision support system (CDSS), that helps them decide on the best strategy to prevent VTE in individual patients. The rates of VTE prevention at each hospital will be compared to each other, and to the rates at St. Joseph's Healthcare Hamilton, which will receive neither the order sets nor the CDSS.
Interventions
BEHAVIORALElectronic Order Entry System + CDSS
Physicians at this hospital will use an Electronic Order Entry System plus a computerized decision support system (CDSS) to support VTE prophylaxis decisions.
BEHAVIORALElectronic Order Entry System Only
Physicians at this hospital will use an Electronic Order Entry System
OTHERUsual Care
Physicians at this hospital will practice usual care (no Electronic Order Entry System and no CDSS for VTE prophylaxis decisions)
Sponsors
Hamilton Health Sciences Corporation
McMaster University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients at least 18 years of age * Hospitalization on a general internal medicine ward
Exclusion criteria
* Receiving therapeutic anticoagulation at time of hospitalization
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of hospitalized medical patients who are appropriately managed for VTE prophylaxis | Participants will be followed for the duration of their hospital stay on a medical ward, an expected average of 5 days | 'Appropriate management' is defined as: (i) appropriate non-receipt of any form of prophylaxis when the patient has no VTE risk factors; (ii) appropriate receipt of pharmacologic prophylaxis when VTE risk factors are present and the patient has no contraindications for pharmacologic prophylaxis; or (iii) appropriate receipt of mechanical prophylaxis, when VTE risk factors are present and the patient has contraindications for pharmacologic prophylaxis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital-acquired venous thromboembolism | Participants will be followed for 30 days, from the date of hospital admission | VTE is defined as the presence of DVT or PE objectively confirmed by at least one of compression ultrasonography, venography, ventilation-perfusion lung scanning, CT pulmonary angiography, or a conventional pulmonary arteriogram. 'Hospital-acquired' VTE is that which is not clinically evident or suspected at the time of admission, but is diagnosed during or up to 30 days after hospital admission. |
| Major bleeding | Participants will be followed for 30 days, from the date of hospital admission | Major bleeding is defined using the International Society of Haemostasis and Thrombosis criteria. |
Countries
Canada
Outcome results
None listed