Impact of a Non-Mandatory Electronic Medical Record Protocol on Venous Thromboembolism Prophylaxis in Adult Hospitalized Patients: A Before-and-After Cohort Analysis of 177,856 Cases
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Background
Venous thromboembolic events (VTE), which include deep vein thrombosis (DVT) and pulmonary embolism (PE) are common conditions within hospitalized patients, and is a well-known cause of in-hospital morbidity and mortality. The evidence on thromboprophylaxis benefits for reduce VTE in hospitalized patients is unequivocal. Despite that, evidence on electronic decision supports systems (e-DSS) and the real impact in VTE prevalence is still lacking.
Methods
A retrospective analysis comprising all admissions between 2017 to 2021, two years before, and two years after the implementation of the e-DSS in a quaternary hospital was carried out. Patients were divided in two groups: pre-e-DSS and post-e-DSS. VTE cases were defined as any occurrence of DVT in the lower or upper limbs, superficial phlebitis, or PE. A subgroup analysis was realized based on patients’ categories of ICD-10 from admission records, including Surgical, Orthopedic, Obstetrical and Clinical admissions. The prevalence of VTE in the pre-e-DSS and post-e-DSS was compared.
Results
A total of 177,851 medical records were included in the analysis. The pre-e-DSS group consisted of 104,943 admissions (59%), while the post-e-DSS 72,913 (41%). A total of 1,059 (0,60%) events of thrombosis were diagnosis in hospitalized patients. In the pre-e-DSS group 584 VTE were diagnosed, the post-e-DSS demonstrated 475. No statistical difference was demonstrated between both groups (p 0,011). The subgroup analysis considering patients from Surgical (p 0,524), Orthopedic (p 0,034) and Obstetrical (p 0,870) admissions demonstrated no statistical difference. The Clinical admissions demonstrated an increase in VTE in the group post-e-DSS (p<0,001).
Conclusion
The use of a non-mandatory electronic protocol for managing venous thromboembolism in patients’ electronic records is insufficient to reduce VTE incidence among hospitalized patients across all groups, including Surgical, Clinical, Orthopedic, and Obstetrical.
