Effectiveness of Evidence-Based Venous Thromboembolism Electronic Order Sets Measured by Health Outcomes

  • Jacob KriveEmail author
  • Joel S. Shoolin
  • Steven D. Zink
Conference paper
Part of the IFMBE Proceedings book series (IFMBE, volume 64)


In this retrospective causal comparative study, we analyzed 5 years of electronic medical records (EMR) data at two large teaching hospitals to determine effectiveness of evidence-based VTE prophylaxis physician order entry systems (CPOE) order sets, measured by acute VTE diagnosis, length of stay (LOS), and comorbidities outcomes. Results indicate lower VTE rate among non-surgical patients, while surgical patients did not benefit. Placing VTE orders via sets was not effective in influencing LOS and comorbidities outcomes. The study highlights the role of medical informatics in improving patient outcomes through reduction of variability in patient care practice.



This work was approved by Advocate Health Care, Downers Grove, Illinois, USA, under IRB protocol #5038. No financial support was provided for this research. There are no conflicts of interest to report.


  1. 1.
    A. Qaseem, V. Snow, P. Barry, E.R. Hornbake, J.E. Rodnick, T. Tobolic, B. Ireland, J.B. Segal, E.B. Bass and K.B. Weiss, “Current diagnosis of venous thromboembolism in primary care: A clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians,” Ann. Intern. Med., vol. 146, pp. 454–458, 2007.Google Scholar
  2. 2.
    F.A. Anderson, H.B. Wheeler, R.J. Goldberg, D.W. Hosmer, N.A. Patwardhan, B. Jovanovic, A. Forcier and J.E. Dalen, “A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study,” Arch. Intern. Med., vol. 151, pp. 933–938, 1991.CrossRefGoogle Scholar
  3. 3.
    J.A. Heit, A.T. Cohen and F.A. Anderson Jr, “Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US,” in ASH Annual Meeting Abstracts, pp. 910, 2005.Google Scholar
  4. 4.
    J.A. Heit, W.M. O’Fallon, T.M. Petterson, C.M. Lohse, M.D. Silverstein, D.N. Mohr and L.J. Melton, “Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study,” Arch. Intern. Med., vol. 162, pp. 1245–1248, 2002.CrossRefGoogle Scholar
  5. 5.
    C.E. Mahan, M.T. Holdsworth, S.M. Welch, M. Borrego and A.C. Spyropoulos, “Deep-vein thrombosis: a United States cost model for a preventable and costly adverse event,” Thromb. Haemost., vol. 106, pp. 405, 2011.Google Scholar
  6. 6.
    E. Kim, “The disease management project, Cleveland Clinic Foundation,” in: Venous Thromboembolism, R. Hobbs, editor [Online]. Clevelend, OH: The Cleveland Clinic Foundation, 2010. Available:
  7. 7.
    B.E. Dixon and M.A. Zafar. (2009, January). “Inpatient computerized provider order entry (CPOE)”. Agency for Health Care Research and Quality [Online]. Available from:
  8. 8.
    S.B. Anderson, S.N. Lin, J. Reiss, D. Skupski, and D. Grunebaum, “Peripartum thromboprophylaxis before and after implementation of a uniform heparin protocol,” J Perinat. Med., vol. 42, pp. 219–223, 2014.Google Scholar
  9. 9.
    C.P. Bourdeaux, K.J. Davies, M.J. Thomas, J.S. Bewley and T.H. Gould, “Using ‘nudge’ principles for order set design: a before and after evaluation of an electronic prescribing template in critical care,” BMJ Qual. Saf., vol. 23, pp. 382–388, May. 2014.CrossRefGoogle Scholar
  10. 10.
    M.R. Cassidy, P. Rosenkranz and D. McAneny, “Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program,” J. Am. Coll. Surg., vol. 218, pp. 1095–1104, 2014.CrossRefGoogle Scholar
  11. 11.
    C.M. Formea, A.F. Picha, M.G. Griffin, J.A. Schaller and M.R. Lee, “Enhancing participant safety through electronically generated medication order sets in a clinical research environment: A medical informatics initiative,” Clin. Transl. Sci., vol. 3, pp. 312–315, Dec. 2010.Google Scholar
  12. 12.
    M.H. Kroll, A. Ferrajoli, L. Cheng, J.L. Watkins and M.A. Rodriguez, “Incidence rate of venous thromboembolism (VTE) and utilization of a VTE prophylaxis order set module In hospitalized patients with leukemia,” Blood, vol. 122, pp. 2946–2946, 2013.Google Scholar
  13. 13.
    D. Vyas, D. Bearelly and B. Boshard, “A multidisciplinary quality improvement educational initiative to improve the rate of deep‐vein thrombosis prophylaxis,” International Journal of Pharmacy Practice, vol. 22, pp. 92–95, 2014.CrossRefGoogle Scholar
  14. 14.
    A.M. Zeidan, M.B. Streiff, B.D. Lau, S. Ahmed, P.S. Kraus, D.B. Hobson, H. Carolan, C. Lambrianidi, P.B. Horn and K.M. Shermock, “Impact of a venous thromboembolism prophylaxis “smart order set”: Improved compliance, fewer events,” Am.J. Hematol., vol. 88, pp. 545–549, 2013.CrossRefGoogle Scholar
  15. 15.
    United States EMR Adoption Model [Online], Chicago, IL: HIMSS Analytics, 2014. Available from

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Jacob Krive
    • 1
    • 2
    • 3
    • 4
  • Joel S. Shoolin
    • 5
  • Steven D. Zink
    • 6
  1. 1.Advocate Health CareDowners GroveUSA
  2. 2.Valence HealthPopulation Health TechnologyChicagoUSA
  3. 3.Department of Biomedical InformaticsNova Southeastern UniversityFort LauderdaleUSA
  4. 4.Department of Biomedical and Health Information SciencesUniversity of Illinois at ChicagoChicagoUSA
  5. 5.Department of Family Medicine, Advocate Medical GroupArlington HeightsUSA
  6. 6.Nevada System of Higher EducationLas VegasUSA

Personalised recommendations