Costly computerized checklist improves blood clot treatment

Forcing physicians to click through a checklist of best practices for preventing blood clots in trauma patients reduced the number of preventable events, according to Johns Hopkins research, although experts question to what extent.

When physicians entered medical orders in the computerized provider order entry-based decision support system, an automated checklist showed evidence-based best treatments, such as low-dose blood thinners or compression devices to keep blood flowing in the legs, according to an announcement. The researchers reported better results than previous methods, which included handing out laminated cards with best treatments or lectures on the subject.

The study, published in the Archives of Surgery, covered 1,599 hospitalized adult trauma patients. It looked at the rate of venous thromboembolisms (VTEs) in 2007, the year before the system was added at the end of the year, compared with rates for 2008 through 2010.

Compliance with guideline-appropriate treatment increased from 66.2 percent to 84.4 percent, and the rate of preventable harm from VTE decreased from 1 percent to 0.17 percent, the authors reported.

Though he lauded the improvement, George C. Velmahos, chief of trauma, emergency surgery and surgical critical care at Massachusetts General Hospital in Boston, wrote in an accompanying critique that the true numbers showed only meager benefits.

"One needs to wonder about the cost-effectiveness of a system that, over four years, saves two patients from an event of unspecified significance," he wrote. Velmahos pointed out that walking remains the best treatment, and medication and compression devices could inhibit that.

One big change as a result of the system, though, was an improved documentation that VTE risk had been assessed in the first 24 hours after admission, MedPage Today reported. It grew from only 3 percent of cases with paper health records in 2007 to 98 percent with the decision tool.

The authors noted that the medical center already had an electronic health system and adding this tool didn't add that much to the cost.

"Implementation of this successful computerized decision-support tool would satisfy one of the core measures of Meaningful Use, enabling healthcare organizations to take advantage of financial incentives, perhaps offsetting the cost of implementing such a system," they wrote.

Clinical decision support systems rank highly on hospital executives' wish lists as they try to document quality improvements for Meaningful Use. They've been pegged as a way to better align research and clinical practice, as long as they can be adapted to clinical workflows.

To learn more:
- read the announcement
- here's the abstract
- check out the critique
- find the MedPage Today article

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