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findings, individual items of the Geneva
Risk Score, type and duration of throm-
boprophylaxis, and in-hospital clinical
outcomes in the standardized electronic
case report form.
According to the Geneva Risk Score
calculated by study personnel, most
patients were classified as having a high
risk for VTE (52.2%), including 432
patients (53.7%) in the e-alert group
and 400 patients (50.7%) in the control
group. About one-quarter of patients
had a high risk of bleeding (25.0% and
23.8%, respectively).
Two-thirds of patients in each study
group received appropriate thrombopro-
phylaxis: 536 patients (66.7%) in the alert
group and 526 patients (66.7%) in the con-
trol group. Inappropriate thromboprophy-
laxis occurred in 16.8 percent of the overall
study group, and was evenly split between
overuse and underuse:
• underuse of VTE prophylaxis: 142
(17.7%) in e-alert group vs. 125
(15.8%) in control group (p=0.33)
• overuse of VTE prophylaxis: 126
(15.7%) vs. 138 (17.5%; p=0.33)
During the study period, rates of appropriate
thromboprophylaxis remained stable in the
overall group (65.4% in the first half vs. 67.9%
in the second half; p=0.29) – suggesting that,
while e-alerts did not improve appropri-
ate thromboprophylaxis, they also did not
interfere with the delivery of thrombopro-
phylaxis. However, in the e-alert group, rates
of appropriate thromboprophylaxis increased
modestly from the first to the second half
(63.1% vs. 70.4%; p=0.028).
Secondary endpoints also did not differ
between the e-alert and control groups, or
between patients who did or did not receive
appropriate thromboprophylaxis:
• all-cause mortality: 55 (6.8%) vs. 50
(6.3%; p=0.69)
• VTE: 8 (1.0%) vs. 11 (1.4%; p=0.46)
• bleeding complications: 48 (6.0%) vs.
8 (1.0%; p=0.42)
“Behavioral
change is needed
to motivate
physicians
to accurately
calculate the risk
score.”
—DAVID SPIRK, MD
Compliance with the e-alert system was
lower than the researchers anticipated: 446
patients (55.5%) either had no score calcu-
lation or had a calculated score result that
was inconsistent with information from the
research nurse–reviewed patient chart.
“Behavioral change is needed to moti-
vate physicians to accurately calculate the
risk score,” the authors concluded, noting
that “simplification of the complex Geneva
Risk Score, with its 19 items, may lead
to improved physician compliance, and
warrants further research.” An automatic
risk-adapted alert system that issues alerts
only for those patients with a high risk of
VTE also may prevent the “alert fatigue”
phenomenon, they added.
The study’s findings are limited by its
single-center design and its reliance on
in-hospital follow-up data, meaning that the
results cannot be extrapolated to long-term
effects of the e-alert system. Also, because
the ordering physicians in the control group
were aware of the ongoing study, they may
have adjusted their rates of appropriate
thromboprophylaxis, potentially obscuring
any difference from the alert group. ●
The authors report financial relationships
with Bayer Health