Implementation of a computerized protocol for anticoagulant therapy

Studies have demonstrated that the use of clinical protocols for a variety of inpatient hospital therapies reduces variation in treatment and often leads to improved outcome. At Latter Day Saints (LDS) Hospital in Salt Lake City, Utah, development of clinical protocols has been given a high level of priority as part of the institution's overall strategy, based on the principles of Total Quality Management, to achieve the highest quality of care possible while simultaneously reducing cost. The use of computers to manage clinical protocols is an area of special study at LDS Hospital that incorporates the use of the HELP (Health Evaluation Through Logical Processing) clinical hospital information system. This research discusses the implementation of a computerized protocol for anticoagulant therapy designed to manage therapy given to patients with deep vein thrombosis on an inpatient general medical/surgical ward. Many details need to be considered in the design of a computerized protocol to strike a balance between computer automation and allowance for clinical judgement and discretion. In addition to technical considerations, a successful implementation of a computerized protocol is largely dependent upon organizational issues such as team management and implementation process.