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BMJ 2005; 330 doi: (Published 17 March 2005) Cite this as: BMJ 2005;330:623
  1. Alison Tonks (, associate editor

Computerised reminder reduces venous thromboembolism in inpatients

A team from Boston has developed a computerised alerting system that improves outcomes for patients. In a large randomised trial, a computer program that reminded doctors to give their inpatients prophylaxis against venous thromboembolism reduced the risk of deep vein thrombosis or pulmonary embolism at 90 days by 41% (hazard ratio 0.59; 95% CI 0.43 to 0.81; P = 0.001).

The program, which was written from scratch, trawled through a Boston Hospital's patient database identifying patients at risk of venous thromboembolism and checking whether they were being treated. The program then randomised the 2506 who weren't being treated to an intervention group (their doctors got a reminder) or a control group. Four fifths of the patients recruited were medical inpatients; most patients recruited had cancer.

Mechanical or pharmacological prophylaxis was ordered for 421 of the 1255 patients in the intervention group (33.5%) and 182 of the 1251 patients in the control group (14.5%, P < 0.001). More importantly, patients in the intervention group were significantly less likely to get a deep vein thrombosis or pulmonary embolus during the next 90 days (figure).

Fig 1

Credit: NEJM

The authors were encouraged by their results, but disappointed that nearly two thirds of the doctors prompted by the program chose to ignore the reminder.

New England Journal of Medicine 2005:352: 969-77

Computerised decision support helps doctors more than patients

In general there's plenty of evidence that computerised decision support can help doctors improve their clinical performance, but it's harder to find evidence that it helps patients. In a systematic review of comparative trials, 62 of 97 studies (64%) found that doctors did better with computerised decision support, reporting improvements in diagnosis, preventive care, and disease management. Fifty two trials looked at one or more patient outcomes, but only seven (13%) found improvements associated with the decision aid. Many of the studies involving …

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