RECRUITINGINTERVENTIONAL

Alerting Providers at Patient Hospital Discharge to Consider Prescribing Rivaroxaban to Reduce Venous Thromboembolism

eVTE (Electronic Venous Thromboembolism): A Cluster, Randomized, Step-wedge Type II Hybrid Study of an Alert Recommending Extended Duration Thromboprophylaxis for At-risk Discharging Medical Patients to Prevent VTE.

About This Trial

A new algorithm derived from only patient age and components of the complete blood count and basic metabolic panel can identify patients discharged from the hospital who may benefit from a blood thinner (called rivaroxaban) to decrease their risk of blood clots, and for whom the risk of bleeding is minimal. The purpose of this study is to evaluate the use of a pop-up alert, which will be seen by clinicians when a discharging patient has been identified as being someone for whom the risk of blood clots is high, but for whom bleeding risk is estimated to be low. The pop-up alert will be enabled in a sequential fashion for each group of hospitals in 1 month blocks. We will look to see if the pop-up alert changes the number of patients who receive rivaroxaban. We will also measure the outcomes of blood clots and bleeding among all discharging patients.

Who May Be Eligible (Plain English)

Who May Qualify: - Discharging clinician must be in one of the following iCentra electronic health record (Cerner, Kansas City, MO) positions: - Physician, nurse practitioner, or physician assistant hospitalist - Physician internal medicine - Physician family medicine - Patient age ≥ 18 years. - The encounter must be inpatient. - A signed hospital discharge order must be present. - eVTE target population criteria (increased venous thromboembolism risk, low bleeding risk) must be met Who Should NOT Join This Trial: - Pregnant during encounter - Discharge order completed by ineligible clinician type - Exclude all cases where the patient is being actively prescribed and intended to be discharged on the following qualifying anticoagulant medications, regardless of dose form or dosing regimen (i.e., they have an active prescription for one of these medications): - Apixaban - Dabigatran - Dalteparin - Enoxaparin - Edoxaban - Betrixaban - Fondaparinux - Rivaroxaban - Warfarin - Creatinine clearance \<30 milliliters/minute based on last-available eligible serum creatinine value preceding discharge - Estimated creatine clearance based on actual body weight (preferred) ((140 - age years) \* measured weight kilograms) / (72.0 \* serum creatine milligrams/deciliter) (\*0.85 if female)) = milliliters/minute - If measured body weight not available, then based on ideal body weight ((140 - age years) \* ideal body weight kilograms) / (72.0 \* serum creatine milligrams/deciliter) (\*0.85 if female)) = milliliters/minute Always talk to your doctor about whether this trial is right for you.

Original Eligibility Criteria

View original clinical language

Inclusion Criteria: * Discharging clinician must be in one of the following iCentra electronic health record (Cerner, Kansas City, MO) positions: * Physician, nurse practitioner, or physician assistant hospitalist * Physician internal medicine * Physician family medicine * Patient age ≥ 18 years. * The encounter must be inpatient. * A signed hospital discharge order must be present. * eVTE target population criteria (increased venous thromboembolism risk, low bleeding risk) must be met Exclusion Criteria: * Pregnant during encounter * Discharge order completed by ineligible clinician type * Exclude all cases where the patient is being actively prescribed and intended to be discharged on the following qualifying anticoagulant medications, regardless of dose form or dosing regimen (i.e., they have an active prescription for one of these medications): * Apixaban * Dabigatran * Dalteparin * Enoxaparin * Edoxaban * Betrixaban * Fondaparinux * Rivaroxaban * Warfarin * Creatinine clearance \<30 milliliters/minute based on last-available eligible serum creatinine value preceding discharge * Estimated creatine clearance based on actual body weight (preferred) ((140 - age years) \* measured weight kilograms) / (72.0 \* serum creatine milligrams/deciliter) (\*0.85 if female)) = milliliters/minute * If measured body weight not available, then based on ideal body weight ((140 - age years) \* ideal body weight kilograms) / (72.0 \* serum creatine milligrams/deciliter) (\*0.85 if female)) = milliliters/minute

Treatments Being Tested

OTHER

EHR (electronic health record) alert

Pop-up alert that informs the discharging clinician that the patient meets criteria to be considered for extended duration thromboprophylaxis

OTHER

No EHR (electronic health record) alert

During the baseline phase while risk is assessed and stored, no alerting occurs

Locations (1)

Intermountain Medical Center

Murray, Utah, United States