Implementation of an electronic health record-based tool increases administration of venous thromboembolism chemoprophylaxis in trauma.

Abstract

Timely initiation of venous thromboembolism chemoprophylaxis remains a challenge in trauma and is recognized as a quality benchmark for the American College of Surgeons Trauma Quality Improvement Program. There are several workflow-related barriers that limit timely administration of venous thromboembolism chemoprophylaxis. Tools embedded within the electronic health record can aid protocol compliance as they are integrated in the care workflow. We hypothesized that implementing an electronic health record-based clinical decision support tool improves venous thromboembolism chemoprophylaxis administration in patients with trauma admission. We conducted a pre- and postintervention study in patients admitted to a level 1 trauma center with a hospital length of stay greater than 2 days from November 2018 to May 2021. An electronic health record tool updated in real time indicating venous thromboembolism chemoprophylaxis status was incorporated into the daily handoff list in February 2020. No other initiatives were implemented at this time. Outcomes were the change in percentage of patients receiving at least 1 venous thromboembolism chemoprophylaxis dose during hospitalization and time to first chemoprophylaxis dose. There were 4,311 patients: 2,174 in the preintervention group and 2,137 in the postintervention group. The percentage of patients receiving venous thromboembolism chemoprophylaxis increased from 57.9% before intervention to 81.8% after intervention (P < .001). Concurrently, there was a decrease in average time to initiation of pharmacologic venous thromboembolism chemoprophylaxis from 2.2 days to 1.6 days (P < .001). We found that implementing an electronic health record-embedded tool increased the proportion of patients receiving venous thromboembolism chemoprophylaxis and decreased the time to first dose of venous thromboembolism chemoprophylaxis. This demonstrates the benefits of using electronic health record-based tools to support trauma protocol compliance.