Thrombocalc: implementation and uptake of personalized postpartum venous thromboembolism risk assessment in a high‐throughput obstetric environment

OShaughnessy Fergal; Donnelly Jennifer C.; Cooley Sharon M.; Deering Mary; Raman Ajita; Gannon Geraldine; Hickey Jane; Holland Alan; Hayes Niamh; Bennett Kathleen; Ní áinle Fionnuala; Cleary Brian J.

摘要

Abstract <section xml:id="aogs13206-sec-0001"> <title type="main">Introduction > Venous thromboembolism risk assessment ( <fc>VTERA</fc> ) is recommended in all pregnant and postpartum women. Our objective was to develop, pilot and implement a user‐friendly electronic <fc>VTERA</fc> tool. </section> <section xml:id="aogs13206-sec-0002"> <title type="main">Material and methods > We developed “Thrombocalc”, an electronic <fc>VTERA</fc> tool using Microsoft <fc>EXCEL</fc> ? . Thrombocalc was designed as a score‐based tool to facilitate rapid assessment of all women after childbirth. Calculation of a total score estimated risk of venous thromboembolism in line with consensus guidelines. Recommendations for thromboprophylaxis were included in the <fc>VTERA</fc> output. Implementation was phased. Uptake of the <fc>VTERA</fc> tool was assessed prospectively by monitoring the proportion of women who gave birth in our institution and had a completed risk assessment. Factors affecting completion and accuracy of risk assessments were also assessed. </section> <section xml:id="aogs13206-sec-0003"> <title type="main">Results > Thrombocalc was used prospectively to risk‐assess 8380 women between September 2014 and December 2015. Compliance with this tool increased dramatically throughout the study period; over 92% of women were risk‐assessed in the last quarter of data collection. Compliance was not adversely affected if delivery took place out of working hours [adjusted odds ratio ( <fc>aOR</fc> ) 1.03, 95% confidence interval ( <fc>CI</fc> ) 0.93–1.14]. Risk assessment was less likely in the case of cesarean deliveries ( <fc>aOR</fc> 0.66, 95% <fc>CI</fc> 0.60–0.73) and stillborn infants ( <fc>aOR</fc> 0.48, 95% <fc>CI</fc> 0.29–0.79). Misclassification of risk factors led to approximately 207 (2.5%) inaccurate thromboprophylaxis recommendations. </section> <section xml:id="aogs13206-sec-0004"> <title type="main">Conclusions > Our electronic, score‐based <fc>VTERA</fc> tool provides a highly effective mechanism for rapid assessment of individual postpartum venous thromboembolism risk in a high‐throughput environment. </section> </abstract> </span> <span class="z_kbtn z_kbtnclass hoverxs" style="display: none;">展开▼</span> </div> <div class="translation abstracttxt"> <span class="zhankaihshouqi fivelineshidden" id="abstract"> <span>机译：</span><abstract xmlns =“http://www.wiley.com/namespaces/wiley”type =“main”xml：id =“aogs13206-abs-0001”> <标题类型=“main”>抽象</ title> <第XML：ID =“AOGS13206-SEC-0001”> <标题类型=“main”>介绍</标题> >所有怀孕和产后都建议使用静脉血栓释放风险评估（<FC> VTERA </ FC>）女性。我们的目标是开发，飞行员和实施用户友好的电子<FC> Vtera </ Fc>工具。 </ p> </ section> <section XML：ID =“AOGS13206-SEC-0002”> <标题类型=“main”>材料和方法</ title> >我们开发了“血小板驱动”，电子<FC >使用Microsoft <FC> Excel </ Fc> 的工具，vtera </ fc>工具？</ sup>。血小板可以设计为基于分数的工具，促进分娩后所有妇女的快速评估。符合协商指南，计算总分估计静脉血栓栓塞风险。缩血丙基乙酸的建议包括在<FC> VTERA </ FC>输出中。实施已相位。通过监测在我们的机构出生的妇女的比例并完成风险评估，前瞻性地评估<FC> Vtera </ FC>工具的摄取。还评估了影响风险评估完成和准确性的因素。 </ p> </ section> <section XML：ID =“AOGS13206-SEC-0003”> <标题类型=“MAIN”>结果</标题> <P>血小板通过前瞻性地用于风险评估9月之间的8380名女性2014年和2015年12月。在整个研究期间，遵守该工具的符合急剧增加;超过92％的女性在上一季度的数据收集中被评估。如果送货完成工作时间[调整后的赔率比（<FC> AOR </ FC>）1.03,95％置信区间（<FC> CI </ FC>）0.93-1.14]，则遵守情况不会受到不利影响。风险评估在循环递送的情况下不太可能（<FC> AOR </ FC> 0.66,95％<FC> CI </ FC> 0.60-0.73）和事故婴儿（<FC> AOR </ FC> 0.48， 95％<FC> CI </ FC> 0.29-0.79）。危险因素的错误分类导致约207（2.5％）不准确的血栓性推荐建议。 </ p> </ section> <section xml：id =“aogs13206-sec-0004”> <标题类型=“main”>结论</ title> >我们的电子，基于分数<fc> vtera </ FC>工具提供了一种高效的机制，可在高吞吐量环境中快速评估个体产后静脉血栓栓塞风险。 </ p> </ section> </ abstract> </span> <span class="z_kbtn z_kbtnclass hoverxs" style="display: none;">展开▼</span> </div> </div> <div class="record"> <h2 class="all_title" id="enpatent33" >著录项</h2> <ul> <li> <span class="lefttit">来源</span> <div style="width: 86%;vertical-align: text-top;display: inline-block;"> <a href='/journal-foreign-17780/'>《Acta Obstetricia et Gynecologica Scandinavica: Official Publication of the Nordisk Forening for Obstetrik och Gynekologi》</a> <b style="margin: 0 2px;">|</b><span>2017年第11期</span><b style="margin: 0 2px;">|</b><span>共9页</span> </div> </li> <li> <div class="author"> <span class="lefttit">作者</span> <p id="fAuthorthree" class="threelineshidden zhankaihshouqi"> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=OShaughnessy Fergal&option=202" target="_blank" rel="nofollow">OShaughnessy Fergal;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Donnelly Jennifer C.&option=202" target="_blank" rel="nofollow">Donnelly Jennifer C.;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Cooley Sharon M.&option=202" target="_blank" rel="nofollow">Cooley Sharon M.;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Deering Mary&option=202" target="_blank" rel="nofollow">Deering Mary;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Raman Ajita&option=202" target="_blank" rel="nofollow">Raman Ajita;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Gannon Geraldine&option=202" target="_blank" rel="nofollow">Gannon Geraldine;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Hickey Jane&option=202" target="_blank" rel="nofollow">Hickey Jane;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Holland Alan&option=202" target="_blank" rel="nofollow">Holland Alan;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Hayes Niamh&option=202" target="_blank" rel="nofollow">Hayes Niamh;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Bennett Kathleen&option=202" target="_blank" rel="nofollow">Bennett Kathleen;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Ní áinle Fionnuala&option=202" target="_blank" rel="nofollow">Ní áinle Fionnuala;</a> <a href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Cleary Brian J.&option=202" target="_blank" rel="nofollow">Cleary Brian J.;</a> </p> <span class="z_kbtnclass z_kbtnclassall hoverxs" id="zkzz" style="display: none;">展开▼</span> </div> </li> <li> <div style="display: flex;"> <span class="lefttit">作者单位</span> <div style="position: relative;margin-left: 3px;max-width: 639px;"> <div class="threelineshidden zhankaihshouqi" id="fOrgthree"> <p>Pharmacy DepartmentRotunda HospitalDublin Ireland;</p> <p>Department of Obstetrics and GynecologyRotunda HospitalDublin Ireland;</p> <p>Department of Obstetrics and GynecologyRotunda HospitalDublin Ireland;</p> <p>Department of MidwiferyRotunda HospitalDublin Ireland;</p> <p>Department of MidwiferyRotunda HospitalDublin Ireland;</p> <p>Department of MidwiferyRotunda HospitalDublin Ireland;</p> <p>Department of MidwiferyRotunda HospitalDublin Ireland;</p> <p>Department of FinanceRotunda HospitalDublin Ireland;</p> <p>Department of AnesthesiaRotunda HospitalDublin Ireland;</p> <p>Division of Population Health SciencesRoyal College of Surgeons in IrelandDublin Ireland;</p> <p>Department of HamatologyRotunda HospitalDublin Ireland;</p> <p>Pharmacy DepartmentRotunda HospitalDublin Ireland;</p> </div> <span class="z_kbtnclass z_kbtnclassall hoverxs" id="zhdw" style="display: none;">展开▼</span> </div> </div> </li> <li > <span class="lefttit">收录信息</span> <span style="width: 86%;vertical-align: text-top;display: inline-block;"></span> </li> <li> <span class="lefttit">原文格式</span> <span>PDF</span> </li> <li> <span class="lefttit">正文语种</span> <span>eng</span> </li> <li> <span class="lefttit">中图分类</span> <span><a href="https://www.zhangqiaokeyan.com/clc/197.html" title="妇产科学">妇产科学;</a></span> </li> <li class="antistop"> <span class="lefttit">关键词</span> <p style="width: 86%;vertical-align: text-top;"> <a style="color: #3E7FEB;" href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=Venous thromboembolism&option=203" rel="nofollow">Venous thromboembolism;</a> <a style="color: #3E7FEB;" href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=risk assessment&option=203" rel="nofollow">risk assessment;</a> <a style="color: #3E7FEB;" href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=risk factors&option=203" rel="nofollow">risk factors;</a> <a style="color: #3E7FEB;" href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=postpartum period&option=203" rel="nofollow">postpartum period;</a> <a style="color: #3E7FEB;" href="/search.html?doctypes=4_5_6_1-0_4-0_1_2_3_7_9&sertext=pregnancy&option=203" rel="nofollow">pregnancy;</a> </p> <div class="translation"> 机译：静脉血栓栓塞;风险评估;危险因素;产后时期;怀孕; </div> </li> </ul> </div> </div> <div class="literature cardcommon"> <div class="similarity "> <h3 class="all_title" id="enpatent66">相似文献</h3> <div class="similaritytab 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FUNCTIONALITY BASED ON MONITORING OF ACTIVITY IN A USER INTERFACE ENVIRONMENT AND/OR CONTROL ACCESS TO SERVICES DELIVERED IN AN ONLINE ENVIRONMENT RESPONSIVE TO OPERATION OF A RISK ASSESSMENT PROTOCOL</a> <b>[P]</b> . <span> 外国专利：  US2018341378A1 </span> <span> . 2018-11-29</span> </div> <p class="zwjiyix translation" style="max-width: initial;height: auto;word-break: break-all;white-space: initial;text-overflow: initial;overflow: initial;"> <span>机译：计算机实现的框架和方法，用于基于对用户界面环境中的活动的监视和/或对在在线环境中针对需要进行的在线服务进行的服务的访问控制，来实现内容和/或用户界面功能的交付 </span> </p> </li> <li> <div> <b>4. </b><a class="enjiyixqcontent" href="/patent-detail/06130406302958.html">Computer-implemented frameworks and methodologies configured to enable delivery of content and/or user interface functionality based on monitoring of activity in a user interface environment and/or control access to services delivered in an online environment responsive to operation of a risk assessment protocol</a> <b>[P]</b> . <span> 外国专利：  AU2016361460A1 </span> <span> . 2018-07-12</span> </div> <p class="zwjiyix translation" style="max-width: initial;height: auto;word-break: break-all;white-space: initial;text-overflow: initial;overflow: initial;"> <span>机译：被配置为基于对用户界面环境中的活动的监视和/或响应于风险评估协议的操作来控制对在线环境中交付的服务的访问的计算机实现的框架和方法，以实现内容和/或用户界面功能的交付 </span> </p> </li> <li> <div> <b>5. </b><a class="enjiyixqcontent" href="/patent-detail/06130408912060.html">COMPUTER-IMPLEMENTED FRAMEWORKS AND METHODOLOGIES CONFIGURED TO ENABLE DELIVERY OF CONTENT AND/OR USER INTERFACE FUNCTIONALITY BASED ON MONITORING OF ACTIVITY IN A USER INTERFACE ENVIRONMENT AND/OR CONTROL ACCESS TO SERVICES DELIVERED IN AN ONLINE ENVIRONMENT RESPONSIVE TO OPERATION OF A RISK ASSESSMENT PROTOCOL</a> <b>[P]</b> . <span> 外国专利：  WO2017088026A1 </span> <span> . 2017-06-01</span> </div> <p class="zwjiyix translation" style="max-width: initial;height: auto;word-break: break-all;white-space: initial;text-overflow: initial;overflow: initial;"> 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