Medical admission order sets to improve deep vein thrombosis prophylaxis rates and other outcomes

J Hosp Med. 2009 Feb;4(2):81-9. doi: 10.1002/jhm.399.


Background: The value of order sets for clinical decision support has not been established.

Objective: To determine whether introduction of admission order sets increases the proportion of inpatients receiving deep venous thrombosis (DVT) prophylaxis.

Design: Before-after study.

Setting: Community hospital.

Patients: General medical patients admitted to hospital.

Intervention: Paper-based admission order sets (instead of free-text orders) for voluntary use by internists, without any education or behavior change interventions.

Measurements: Primary outcome was proportion of medical admissions ordered DVT prophylaxis. Secondary outcomes included overall utilization of DVT prophylaxis in medical inpatients and other admission order care quality measures.

Results: Prior to introduction of order sets, DVT prophylaxis was ordered in 10.9% of patients. Patients admitted with order sets were more likely to be ordered DVT prophylaxis than patients admitted with free-text orders (44.0% versus 20.6%, by months 14 and 15, P<0.0001). Hospital-wide DVT prophylaxis in medical inpatients increased from 12.8% to 25.8% of patient-days (P<0.0001). Order set use improved many other secondary outcomes (P<0.05 for all), including allied health consultations (62.8% versus 12.7%), use of standardized diabetic diet (17.0% versus 5.1%), insulin sliding scale (19.1% versus 7.6%), potassium replacement protocol (63.8% versus 0.51%), documentation of allergies (54.3% versus 9.6%) and resuscitation status (57.4% versus 10.2%), and reduced orders for inappropriate laboratory tests such as blood urea nitrogen (39.4% versus 59.0%).

Conclusions: The broad impact of order sets and minimal organizational resources required for their implementation suggests that order sets may have wide applicability as a clinical decision support tool.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Cutaneous
  • Aged
  • Clinical Protocols
  • Decision Support Systems, Clinical
  • Drug Utilization Review
  • Female
  • Heparin / administration & dosage
  • Heparin / therapeutic use*
  • Hospitals, Community / standards*
  • Humans
  • Internal Medicine / standards
  • Male
  • Medical Audit*
  • Medical Order Entry Systems*
  • Middle Aged
  • Ontario
  • Patient Admission*
  • Premedication / statistics & numerical data*
  • Prescriptions
  • Retrospective Studies
  • Stockings, Compression / statistics & numerical data*
  • Venous Thrombosis / drug therapy
  • Venous Thrombosis / prevention & control*


  • Heparin