Wednesday, March 16, 2005

Electronic Alerts to Improve Hospital Outcomes

Here is the reference to an article that appeared in the New England Journal of Medicine. Basically it describes a very innovative randomized study that evaluated an "electronic alert" system. These alerts were computer-generated to notify admitting physicians that inpatients of theirs meeting specific criteria were at high risk of thromboembolic events (e.g., blood clots in the legs or lungs).

Half of the patients were subject to the alerts and half were not (the standard of care). These alerts reminded the admitting physician that it might be advantageous to place such patients on some type of prophylaxis such as anticoagulants, compression stockings, etc. The physician could then elect to apply such prophylaxis or not depending on his preference. Hospitalized patients can be at risk for such events for a variety of reasons and the amount of morbidity and death is significant.

It turned out that physicians taking care of the patients subject to the alerts were more likely to place their patients on prophylaxis then with the control group. More importantly, those patients did better and were 41% less likely to actually have an actual adverse event then the control group.

So this relatively simple, easily engineered computer program had a marked impact on patient outcomes.

As a hospitalist (one who specializes in taking care of inpatients in acute care facilities) attempts by hospitals to initiate such interventions have always been annoying to me. While admitting patients with certain medical problems, I have often been confronted with pre-printed admission orders for given diseases used to gently prod me to address specific issues.

I had always found such pre-printed orders annoying. I felt that I as an experienced physician, I knew how to take care of my patients and the last thing I needed was the product of some bureaucratically entangled "forms committee" to tell me how to manage patients. Nor was my (occasionally pig-headed view?) rare among doctors.

Studies like this with such dramatic results are very hard to ignore. There is no doubt that as physicians involved in patient care, we are going to see a lot more of this type of intervention. It may be annoying (and perhaps personally embarrassing to admit to ourselves that we missed something) but after all, it's the patient outcome that matters.

Measures such as this can make hospitals safer places to be.

(I violated my usual rule of never updating my posting because I wrote a really stupid sentence construction!)

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Blogger Henry Stern, LUTCF, CBC said...

Seems to me that there's more of a method to this madness than appears at first blush (okay, maybe that was little heavy on the metaphors).

My take on this is that the provider (in this case, a hospital) is looking to limit its liability exposure if/when something "bad" happens:

"Your Honor, we gave Dr Ford pre-printed, explicit instructions which he failed to follow. Please let us off the hook."

And BTW, Thank You for the kudos (below). I found your site courtesy of His Lordship Sir Hewitt, and I'm sure glad I did. ;-)

March 16, 2005 3:28 PM  

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