Electronic Strategies to Enhance Venous Thromboemboli (VTE) Prophylaxis in Hospitalized Medical Patients

Study Overview
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Brief Summary
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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.

Official Title
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Electronic Strategies to Enhance Venous Thromboprophylaxis in Hospitalized Medical Patients

Conditions
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Venous Thromboembolism

Intervention / Treatment
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* Behavioral: Electronic Order Entry System + CDSS
* Behavioral: Electronic Order Entry System Only
* Other: Usual Care


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hamilton General Hospital<br> | Behavioral: Electronic Order Entry System + CDSS<br>* Physicians at this hospital will use an Electronic Order Entry System plus a computerized decision support system (CDSS) to support VTE prophylaxis decisions.<br>|
| Active Comparator: Juravinski Hospital<br> | Behavioral: Electronic Order Entry System Only<br>* Physicians at this hospital will use an Electronic Order Entry System<br>|
| Other: St. Joseph's Hospital<br> | Other: Usual Care<br>* Physicians at this hospital will practice usual care (no Electronic Order Entry System and no CDSS for VTE prophylaxis decisions)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of hospitalized medical patients who are appropriately managed for VTE prophylaxis | '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. | Participants will be followed for the duration of their hospital stay on a medical ward, an expected average of 5 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital-acquired venous thromboembolism | 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. | Participants will be followed for 30 days, from the date of hospital admission | 
| Major bleeding | Major bleeding is defined using the International Society of Haemostasis and Thrombosis criteria. | Participants will be followed for 30 days, from the date of hospital admission | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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venous thromboembolism, thromboprophylaxis, anticoagulants, hospitalized medical patients, electronic order sets, decision support, knowledge translation, patient safety