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Computer-Alert System Reduces Blood Clots

When prompted, physicians must decide whether to give preventive treatment

WEDNESDAY, March 9, 2005 (HealthDay News) -- A computer system that alerts doctors when a hospitalized patient is at risk for getting blood clots in the veins, called deep vein thrombosis (DVT), helped reduce the condition by 41 percent, researchers report.

"That is a huge reduction," said Dr. Samuel Z. Goldhaber, senior author of the study, which appears in the March 10 issue of the New England Journal of Medicine. Goldhaber is also director of the Venous Thromboembolism Research Group at Brigham and Women's Hospital and an associate professor of medicine at Harvard Medical School.

The alert system was also "especially effective in [preventing] pulmonary embolism, which is more life-threatening than deep vein thrombosis, or DVT," he said.

Pulmonary embolism (PE) is a blockage in an artery in the lung that occurs when a blood clot (embolus) travels to the lungs. DVT describes a blood clot in a deep vein in the legs; the condition can affect airline passengers or others in cramped quarters for long periods, as well as hospitalized patients.

DVT occurs in up to 2 million Americans each year, according to American Heart Association estimates.

Goldhaber's team developed a computer program linked to a hospital database. Using eight common risk factors to determine each patient's risk profile for DVT, the program identified more than 2,500 adult patients in the hospital at increased risk of the condition.

About half the patients were assigned to the intervention group, in which their doctors were alerted when the patients were at high risk for DVT (a score of at least 4), but not receiving preventive measures. The other half were assigned to the control group, in which no computer alert was issued when risk was increased.

According to Goldhaber, preventive measures can be mechanical -- devices such as compression stockings or boots -- or pharmacological, such as prescribing heparin or Coumadin (warfarin).

At the end of 90 days, the team assessed the number of patients who got DVT or PE.

As a result of the alert, more patients in the intervention group received preventive measures, and there were at total 61 DVTs or PEs by the end of the study -- a much smaller number than the 103 cases occurring in the control group.

"We've known for a long time there are effective measures to prevent DVT," Goldhaber said. "The big problem has been to get implementation of these prevention measures in hospitalized patients at high risk. Multiple surveys of different hospitals have shown there is a big lag in implementing prophylaxis orders." Sometimes, the order for some kind of preventive care is overlooked altogether, he added.

The study is a good one and the concept is sound, but patients shouldn't expect this system to appear at a lot of hospitals quickly, said Dr. Michael Herbst, medical director of Santa Monica-UCLA Medical Center.

"In this model -- and it was a good one -- the physician was required to respond [when the computer alerted him to the risk]," Herbst said.

However, the financial investment necessary to implement these alert systems is a big stumbling block for many hospitals, Herbst said. And it's not the only one.

"Some physicians worry about the time it takes to use the computer," he said. "And they are not sure of the payoff."

The system used in the study is similar to those used to alert physicians to medication errors before medicine is administered, which some -- but not all -- studies have deemed effective.

In an editorial accompanying the study, Dr. Pierre Durieux from Hopital Europeen Georges Pompidou, Paris, points out many limitations of the computer alert systems, including delivering the alert with a simple message and limiting them to high-risk problems so the doctor won't be tempted to ignore them.

Durieux also pointed out that while the Goldhaber team proved the effectiveness of the program, it is not known how easily the software used could be put into place at other hospitals.

But in the paper, Goldhaber and his co-authors conclude that "hospitals with adequate information-systems resources should consider implementing electronic alerts" to reduce rates of DVT and PE.

More information

To learn more about preventing DVT, visit the Coalition to Prevent DeepVein Thrombosis.

SOURCES: Samuel Z. Goldhaber, M.D., cardiologist and director, Venous Thromboembolism Research Group, Brigham and Women's Hospital, and associate professor, medicine, Harvard Medical School, Boston; Michael Herbst, M.D., medical director, Santa Monica-UCLA Medical Center, Santa Monica, Calif., and associate professor, family medicine, UCLA David Geffen School of Medicine, Los Angeles; March 10, 2005, New England Journal of Medicine
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