A human factors approach to improving electronic performance measurement of venous thromboembolism prophylaxis

Objective: In 2011, our institution developed a venous thromboembolism (VTE) prophylaxis order set to monitor prophylaxis management through physician-generated risk assessment orders. Prophylaxis rates obtained using the risk assessment orders were falsely low compared with chart review. Our goal was to redesign the order set to increase the percentage of VTE risk assessments ordered, both to improve care and to better reflect performance. Design: Quality Improvement Project. Setting: Veterans Health Administration. Participants: Patients admitted to acute care and intensive care medical units. Interventions: Process analysis was used to identify systems failures limiting use of the original order set. The order set was redesigned using a human factors approach. Main Outcome Measure: VTE risk assessment orders. Results: The order set was redesigned to reduce complexity and improve integration into provider workflow. The rate of risk assessment orders placed within 24 h increased from 48.6 to 80.4% (P < 0.001). There was no difference in the actual use of prophylaxis. However, for patients on prophylaxis, the rates of having a documented 'moderate' or 'high' risk assessment within 24 h increased from 66.7 to 95.7% (P < 0.001). Conclusions: Using human factor principles to redesign an order set led to a significant increase in the percentage of patients with a risk assessment order placed within 24 h of admission. Although the risk assessments using the redesigned order set better reflected physician performance, it remained an imperfect measure for VTE prophylaxis. New technology used to measure human performance must be evaluated following implementation to assess accuracy. Published by Oxford University Press in association with the International Society for Quality in Health Care 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.