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Checklist System Helps Cut Hospital Blood Clot Cases

Checklist illustration (


Johns Hopkins University medical center in Baltimore reports a computerized checklist system helped prescribe appropriate preventive treatments and reduce the number of blood clots in hospitalized trauma patients. The findings from the project are described in this month’s issue of the journal Archives of Surgery (paid subscription required).

The hospital installed a computerized checklist system in January 2008 to help physicians identify and use the best methods of preventing dangerous venous thromboembolisms (VTEs) that includes blood clots in the legs and lungs. Cleveland Clinic cites studies estimating about 1 million cases of VTEs in the U.S. each year, with two-thirds of the cases a result of hospitalization.

VTEs  in hospitals are considered preventable, and before the checklist, Johns Hopkins provided staff lectures and handed out laminated cards outlining best practices for preventing the condition. Elliott Haut, professor of surgery at Johns Hopkins and the study leader notes, “We tried education alone for years and still only 40 to 60 percent of patients were getting optimal treatment.”

The automated checklist recommends evidence-based best treatments for each patient’s needs, usually the regular administration of low-dose blood thinners or the use of compression devices to keep blood flowing in the legs. After information is input about the patient’s case, the software suggests appropriate treatment for prevention. Doctors can still override the system if they choose. “The computerized tool makes ordering the right thing really easy,” says Haut.

The research team examined the records of 1,599 hospitalized adult trauma patients staying more than one day, from 2007, a year before the checklist system, through 2010. The findings showed a higher rate of improvement in preventive treatment orders among patients who had no indications — such as bleeding risk — for receiving the low-dose blood thinners. Compliance with the treatment guidelines increased from 66 percent before to 84 percent after installation of the checklist system.

The rate of preventable VTEs overall in patients also dropped over this period, from 1.0 percent to 0.17 percent. Most of the decline occurred in cases of deep vein thrombosis in patients’ legs, which dropped from 2.26 percent of trauma patients to 0.25 percent in the last year of the study. However, the rate of pulmonary embolisms — blood clots in the lungs — stayed steady throughout study period.

The computerized checklist system was designed for and integrated with Johns Hopkins electronic medical records system, which Haut acknowledges not every hospital currently has. He notes that the expense of adding the VTE checklist to existing electronic systems is minimal now that Johns Hopkins has designed the program.

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