Computerized reminder for prophylaxis of deep vein thrombosis in surgical patients

The objective of the study was to develop a computerized reminder system to ensure that preoperative deep vein thrombosis (DVT) prophylaxis (anticoagulation or compression devices) was provided for eligible patients. The study design was a prospective trial with historic controls. The setting was LDS Hospital in Salt Lake City, Utah, a tertiary care teaching center. The alternate hypothesis stated that a computerized reminder system would increase the rate of DVT prophylaxis in surgical patients. A local consensus was developed among surgeons as to which procedures should receive DVT prophylaxis. The historic rate of DVT prophylaxis was measured for these procedures at 83.8% (794 of 948 eligible cases). A computerized reminder system was implemented on the hospital's computer system, which flagged patients scheduled for a procedure for which DVT prophylaxis was indicated. The rate of DVT prophylaxis was then remeasured. For the 3 months after the introduction of the reminder, compliance with DVT prophylaxis rose to 99.3% (1118 out of 1126 eligible cases). Fourteen of 54 types of procedures showed statistically significant improvement in the rate of DVT prophylaxis between the study group and the historic controls. The procedures which did not show improvement had a small number of cases (n<8) or else were already at a high level of prophylaxis (prophylaxis rate>90%). When individual procedures were combined into groups of similar surgeries, 7 of 10 groups showed statistically significant improvement. Similarly, 3 of 4 surgical divisions showed statistically significant improvement. For all cases combined, the rate of DVT prophylaxis showed highly significant improvement (p<.001) between the historic controls (83.8%) and the study group (99.3%). The conclusion of the study was that a computerized reminder appeared to be an effective method of increasing the rate of DVT prophylaxis in surgical patients