Photo Credit: ALIOUI Mohammed Elamine

A clinical decision support tool, implemented through an Epic-based best practice advice system, significantly increased venous thromboembolism (VTE) prevention in emergency department (ED) observation unit patients, with a notable rise from 0.9% to 4.8% of patients receiving medication after staying for more than 24 hours, emphasizing the impact of electronic health record-based interventions on patient care.

The following is a summary of “An Electronic Medical Record Intervention to Increase Pharmacologic Prophylaxis for Venous Thromboembolism in Emergency Department Observation Patients” published in the January 2024  issue of Emergency Medicine by Baugh, et al.

The significance of venous thromboembolism (VTE) prophylaxis in patients under emergency department (ED) observation unit care remains uncertain. For a study, researchers sought to look into a clinical decision support tool based on electronic health records that aims to get more at-risk patients in ED observation units to use medication VTE prevention. 

They did a delayed time-series study of an Epic-based best practice advice that was put into place in May 2019 at a healthcare system with two university medical centers, four community hospitals, and specialized ED observation units. The best practice advice told staff 24 hours in advance to do a risk assessment and was tied to an order set for VTE prevention. To determine the intervention’s effect, they used a Bayesian structured time series, an interrupted time series, and a multivariable mixed-effect regression model. Before the best practice guidance was implemented, 8,895 ED observation unit patients stayed for more than 24 hours, and only 0.9% were given medication to prevent VTE. After that, 12,664 ED observation unit patients stayed for more than 24 hours, and 4.8% were given medication to prevent VTE. 

The interrupted time series and direct impact analysis showed that VTE prevention went up statistically significantly (absolute percent difference 3.8%, 95% CI 3.5 to 4.1). In a model with many variables, only the intervention was strongly linked to VTE prevention (OR 4.56, 95% CI 2.22 to 9.37). An alert based on electronic health records helped remind staff taking care of ED observation unit patients who were at risk for VTE because they were staying there for a long time to order the suggested drug prevention. It was unclear what the best risk assessment model is or how often VTE events happen in this group.

Source: sciencedirect.com/science/article/abs/pii/S0196064423006704