Electronic health record risk-stratification tool reduces venous thromboembolism events in surgical patients

• Published in: Surgery open science Vol. 9; pp. 34 - 40
• Main Authors: Rastogi, Radhika, Lattimore, Courtney M., Mehaffey, J. Hunter, Turrentine, Florence E., Maitland, Hillary S., Zaydfudim, Victor M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2022; Elsevier
• Subjects: EHR clinical decision support; Electronic dashboard; Original; Risk stratification tool; Venous thromboembolism reduction; Risk stratification tool; SCD; VTE; EHR clinical decision support; Venous thromboembolism reduction; Electronic dashboard; EHR; VTE, venous thromboembolism; SCD, sequential compression devices; EHR, electronic health record
• ISSN: 2589-8450; 2589-8450
• DOI: 10.1016/j.sopen.2022.04.003

Venous thromboembolism is a preventable cause of morbidity and mortality after surgery. To ensure that patients receive appropriate venous thromboembolism chemoprophylaxis, a nonmandatory risk-stratification tool based on patient clinical condition was implemented through the electronic health record to stratify patient risk and recommend chemoprophylaxis. We hypothesized that implementing this tool would reduce postoperative venous thromboembolism events in general surgery as well as across all surgical services. All adult patients undergoing inpatient surgical operations (January 2012–December 2019) at a single quaternary care center and Level 1 trauma center were abstracted from institutional electronic health record database and stratified into patients admitted before and after venous thromboembolism risk-stratification tool implementation. Bivariable analyses compared venous thromboembolism chemoprophylaxis prescription and venous thromboembolism events with implementation and screening among all surgical patients as well as in general surgery patient subset. A total of 64,377 adults underwent operations: 27,819 preimplementation and 36,558 postimplementation. A significant reduction in venous thromboembolism events occurred from pre- to post-tool implementation for all cases (0.77% vs 0.47%, P < .001). General surgery patients (n = 15,723) had a significant increase in chemoprophylaxis prescription (81.9% vs 86.0%, P < .001) and a significant reduction in venous thromboembolism events (1.41% vs 0.59%, P < .001). After tool implementation, use of extended postdischarge chemoprophylaxis was greater among general surgery patient subset than the entire patient cohort (46.7% vs 29.6%, P < .001). The integration of a nonmandatory electronic health record risk-stratification tool was associated with a significant reduction in venous thromboembolism events. Extended chemoprophylaxis was prescribed in nearly half of general surgery patients at very high risk for postdischarge events. •Implementing an electronic VTE risk-stratification tool reduced surgical VTE events.•Even as a nonmandatory tool, risk stratification led to overall fewer VTE events.•Postoperative VTE events were reduced by 39% after the tool was integrated in EHR.•With the tool, general surgery had 58% less VTE events and improved prophylaxis use.