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Electronic alerts to prevent venous thromboembolism among hospitalized patients
Kucher, N., Koo, S. , Quiroz, R., Cooper, J., Paterno, M., Soukonnikov, BS, and Goldhaber, S. Electronic alerts to prevent venous thromboembolism among hospitalized patients. NEJM 352(10):969 (March 10, 2005)

Below is commentary on the above article by the author:
Dr. Samuel Z. Goldhaber
Brigham and Women’s Hospital
Director, Venous Thromboembolism Research Group
Director, Anticoagulation Service
Staff CardiologistHarvard Medical School
Associate Professor of Medicine

Commentary
I’ve been intrigued by pulmonary embolism (PE) ever since I was a medical student. I remember a patient who died with presumed PE who had no PE at autopsy. Another patient died in our Coronary Care Unit with unsuspected massive PE that was discovered on postmortem examination.Despite the glitz of high tech diagnosis with multislice chest CT, and the excitement of administering thrombolysis to an ill patient with massive or submassive PE, the most cost-effective approach is prevention of PE. It involves following a low-tech, somewhat dull routine. Yet, PE is much easier to prevent than to diagnose than to treat.It’s so frustrating to know that we have effective prevention tools that are underutilized in hospitalized patients at high risk of DVT and PE. This is mostly a problem on medical services, because surgical services have become excellent at implementing prophylaxis. Therefore, as a quality improvement initiative, we organized a trial of order entry computer alerts for high-risk patients not receiving prophylaxis. We carried out this program in a setting where a wealth of educational information already existed on hospital websites and where multiple seminars and lectures have been convened to discuss venous thromboembolism prophylaxis. 83% of the patients were medical service patients. The results of our program show that timely reminders about at-risk patients can lead to 41% fewer clinically diagnosed and imaging-confirmed DVTs and PEs.

Role of the Hospitalist
Hospitalists are well positioned to target prevention efforts against predictable complications of serious illness. Hospitalists have the opportunity to critically review DVT prophylaxis, provide hospital-specific data to clinicians, identify and lower barriers, devise strategies to bridge the gap between knowledge and practice, develop automated reminder systems, and participate in clinical research.