Implementation of a mandated venous thromboembolism clinical order set improves venous thromboembolism core measures.

BACKGROUND: Venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, is a major cause of morbidity and mortality. It results in approximately 300 000 deaths in the United States each year, and two thirds of VTE events are hospital acquired. However, VTE prophylaxis for hospitalized patients remains suboptimal. OBJECTIVES: Assess the effect of a physician-mandated VTE prophylaxis computerized order set on the rates of hospital acquired VTE. METHODS: A retrospective prevalence study of hospitalized patients pre- and postimplementation of a mandatory VTE order set. Additionally, the Joint Commission VTE Core Measures data was tracked for improvements postimplementation. RESULTS: At baseline, 73% of patients received appropriate prophylaxis (n = 148) compared with 90% (n = 192) postintervention (P = 0.015). The percentage of patients who received VTE prophylaxis within 24 hours of arrival at the hospital increased from a baseline of 73% to 93% postimplementation (P = 0.0004). Hospital-acquired VTE prevalence rates decreased from 2% (4 cases) to 0.05% (1 case; P = 0.37) post intervention. The incidence of potentially preventable VTE cases (the Joint Commission's core measure 6) decreased from 3.9% to 0% (P = 0.39). These differences were not statistically significant, but they are clinically significant. These results were also sustained over time. CONCLUSION: This study demonstrates that a mandated physician VTE order set ensures that nearly all patients will be stratified for VTE risk and provided with prophylaxis based on their risk category. Adhering to the evidence-based clinical practice guidelines from the American College of Chest Physicians is effective in improving prophylaxis and decreasing the rate of hospital-acquired VTE in hospitalized patients, and in decreasing the rate of preventable VTE cases based on the Joint Commission's core measure 6.

The effect of the "mini" incision in total hip arthroplasty on component position.

This study compares cemented and uncemented total hip arthroplasties performed through either a standard or mini incision. The parameters evaluated were dislocation rates, Gruen and DeLee zones, Barrack cement grading, component positioning, and heterotopic bone levels. There were no statistically significant differences found between the mini and standard incision groups except in 2 parameters. Analysis of femoral stems not in neutral position revealed statistically significant differences between cemented and uncemented stems. The mean anteversion of the mini incision cup was also significantly less than the standard group, although probably not clinically significant. In conclusion, the mini incision does not compromise total hip arthroplasty results on the acetabular side, but varus positioning of the cemented femoral component nearing 2 degrees is concerning for the long-term success of these arthroplasties.