A standardized DVT risk assessment program was developed and incorporated into the Computerized Patient Record System for all surgical patients at the Jesse Brown Veterans Affairs Medical Center. Four hundred consecutive surgical patients before and after implementation were evaluated for DVT risk, the prescription of pharmacological and mechanical DVT prophylaxis, and the development of thromboembolic events.
With implementation of the DVT risk assessment program, the number of patients receiving the recommended pharmacological prophylaxis preoperatively more than doubled (14 % to 36 % ) (P < .001), and use of sequential compression devices (SCD) increased 40 % (P < .001). Overall, the percentage of at-risk patients receiving the recommended combined DVT prophylaxis of SCD and pharmacological prophylaxis increased nearly seven-fold (5 % to 32 % ) (P < .001). The assessment also improved use of prophylaxis postoperatively, increasing SCD use by 27 % (P < .001). With respect to DVT occurrence, there was an 80 % decrease in the incidence of postoperative DVT at 30 days and a 36 % decrease at 90 days; however, this did not reach statistical significance due to the low event rate.
The creation and implementation of a standardized DVT risk assessment program in the electronic medical record significantly increased use of pharmacological and mechanical DVT prophylaxis before surgery in a Veterans Affairs Medical Center setting.