The use of computerized clinical decision support systems (CCDSSs) led to a reduction in the risk of post-operative venous thromboembolism (VTE) and increased use of VTE prophylaxis in surgical patients, according to results from a literature review published in JAMA Surgery.
The researchers identified clinical trial reports and observational studies of surgical patients published between October 15, 1991, and February 16, 2016, to evaluate the effect of CCDSSs on VTE risk stratification and prophylaxis ordering, compared with routine care without a decision support system. The report included 11 articles (9 prospective cohort trials and 2 retrospective cohort trials), comprising 104,241 patients in the intervention group and 52,125 in the control group.
In their meta-analysis, the authors observed that the use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio = 2.35; 95% CI 1.78-3.10; p<0.001). The risk of VTE events was also significantly reduced when CCDSSs were used (risk ratio = 0.78; 95% CI 0.72-0.85; p<0.001).
“Health-care professionals do not adequately stratify risk or provide prophylaxis for VTE among surgical patients,” the authors stated. “We should not ignore the strength of computer science in medicine … but the successful implementation of a CCDSS and physician acceptance depend on further trials that lend support to the efficacy of CCDSSs, their cost utility, their user acceptability, and, most important, their ability to change patient outcomes.”
The study’s finding is limited by confounding factors that may limit the ability to draw a direct causal relationship between reduced risk for VTE and CCDSSs implementation.
Source: Borab ZM, Lanni MA, Tecce MG, et al. Use of computerized clinical decision support systems to prevent venous thromboembolism in surgical patients: a systematic review and meta-analysis. JAMA Surg. 2017 March 15. [Epub ahead of print]