Int J Qual Health Care. 2021 Feb 27:mzab034. doi: 10.1093/intqhc/mzab034. Online ahead of print.
BACKGROUND: Venous thromboembolism (VTE) is an important patient safety concern resulting in significant mortality, morbidity, and a burden on healthcare resources. Despite the widespread availability of evidence-based clinical practice guidelines (CPGs) on VTE prophylaxis, we found that only 50.9% of our patients were receiving appropriate prophylaxis. This study aimed to evaluate the impact of automation of an adapted VTE prophylaxis CPG through a clinical decision support system (the VTE-CDSS) to prevent VTE among hospitalized adult patients through comprehensive multi-faceted implementation strategies.
METHODS: Quasi-experimental study design (pre- and post-implementation). The study was conducted at a large 900-bed tertiary teaching multi-specialty hospital in Riyadh, Saudi Arabia. A total of 1809 adult patients were included in the study: 871 during the pre-implementation stage and 938 in the post-implementation stage. Multi-faceted implementation interventions were utilized including leadership engagement and support, quality and clinical champions, staff training and education, and regular audit and feedback. Two rate-based process measures were calculated for each admission cohort (i.e. pre/post-implementation); the percentage of inpatients who have been assessed for VTE risk on admission and the percentage of inpatients who have received appropriate VTE prophylaxis. Additionally, two outcome measures were calculated including the prevalence of Hospital-acquired VTE events and the in-hospital all-cause mortality.
RESULTS: The percentage of inpatients who have been risk assessed for VTE on admission increased from 77.4% to 93.3% (P<0.01). the percentage of the those who have received appropriate VTE prophylaxis increased from 50.9 % to 81.4% (P<0.01). In total, the hospital-acquired VTE (HA-VTE) events decreased by 50 % from 0.33% to 0.15% (P<0.01) All-causes in hospital mortality did not show statistically significant difference before and after implementation of the VTE-CDSS (P>0.05).
CONCLUSION: The VTE-CDSS was able to improve patient safety by enhancing the adherence to the VTE prophylaxis best practice and adapted CPG. The adopted multifaceted implementation strategies’ approach had shown successful improvement of the compliance rate of risk assessment, adherence to prophylaxis recommendations, and substantial reduction of the HA-VTE prevalence. Furthermore, a successful CDSS needs to have a set of critical components to ensure better user compliance and positive patient outcomes for such a system.