Seeking the Right Time for Venous Thromboembolism Prophylaxis Alerts

Area of Science:

• Healthcare Informatics
• Clinical Decision Support Systems
• Patient Safety

Background:

• Automated provider alerts for venous thromboembolism (VTE) prophylaxis are common.
• A
• snooze
• function allows users to delay repeat alerts, leading to high VTE alert snoozing rates (67%).

Purpose of the Study:

• To decrease alert burden by 25% by increasing the snooze delay for VTE prophylaxis alerts.
• To evaluate the impact of extended snooze delays on alert frequency and adherence to VTE prophylaxis guidelines.

Main Methods:

• A tertiary care academic medical center implemented changes to the snooze delay for VTE alerts (1, 2, and 3 hours).
• Data collected included alerts per 100 admissions, percentage of alerts snoozed, pharmacoprophylaxis rates, and VTE core measure satisfaction.
• Primary outcome: alerts per 100 admissions. Secondary outcomes: snooze percentage, pharmacoprophylaxis, and core measure adherence.

Main Results:

• No significant change in alerts per 100 admissions (168 vs. 176, p=0.375) or pharmacoprophylaxis rates (50.9% vs. 50.9%, p=0.997).
• A small reduction in alert snoozing (67.0% to 63.2%, p<0.001) and a slight increase in core measure satisfaction (86.0% to 88.0%, p=0.025) were observed.
• Post-hoc analysis showed an increased median interval between same-patient, same-provider alerts (3.4 to 8.3 hours). Internal medicine hospitalists snoozed 78% of their VTE alerts.

Conclusions:

• Increasing snooze delay time did not effectively decrease the overall alert burden.
• Modifying alert parameters alone is insufficient to reduce alert burden; changes in provider response culture are necessary.