229 EMR clinical decision support tools improve compliance with venous thromboembolism risk assessment in obstetrical patients

Abstract

NYU Langone Health System developed a standardized screening and treatment policy for Obstetric venous thromboembolism (VTE) risk assessment. Our objective was to determine if utility of EMR Clinical Decision Support Tools (CDST) can improve compliance in completing OB VTE risk assessment on admitted obstetrical patients. In March 2020 a New Policy standardizing OB VTE risk assessment was introduced at three hospitals and providers were educated on use of new scoring tool and VTE Score Smartlink (inserts score into note) created in EPIC EMR system. Three hospitals had baseline differences in use of H&P and VTE risk assessment documentation and operational structure. Hospital A used provider specific note templates while hospitals B and C used hospital specific standardized H&P. On June 11, 2020, a health systems standardized H&P with built in CDST was created and introduced at all 3 hospitals. CDST included “Disappearing HELP Text” with a “Refreshable Link” to VTE Scoring tool - a non-interruptive notification indicating scoring is incomplete with direct link to the scoring tool. We assessed the impact of CDST on the rate of compliance with documentation of VTE risk assessment. From April to July 2020 a total of 3786 obstetric patients admitted to L&D were assessed (A 1470, B 961, C 1355). Maternal and neonatal characteristics included age, race, ethnicity, estimated blood loss, gestational age, mode of delivery, maternal BMI, APGAR <7 at 1 and 5 minutes, and birthweight, and total VTE risk assessment scores were assessed without clinically significant differences. OB VTE assessment on admission increased significantly with CDST at all three hospitals: A: 17.8% vs 90.9% (p<.0001); B: 88.8% vs 94.6% (p< 0.005); C: 69.3% vs 80.5 (P<.0001) (Figure 1). All hospitals had sustained compliance rate over time (Figure 2). We demonstrate effective use of clinical decision support tools in EMR to improve compliance with completion of obstetric VTE risk assessment on admission. Similar CDST can be applied to improve other quality metrics and patient outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)