Literature Scan
In this study, a computer-based e-alert
system automatically identified adult
patients hospitalized at the University
Hospital in Bern who were not receiving
anticoagulation. Patients were randomized
1:1 to either the e-alert group (n=804; in
which an alert and the Geneva Risk Score
calculation tool were issued directly in
the electronic patient chart) or the control
group (n=789; in which no alert was issued).
The Geneva Risk Score calculates a patient’s
risk for VTE on a scale of one to 22 (22
representing highest risk for VTE), ac-
counting for age, history of VTE, surgery,
active malignancy, and other factors that
might raise VTE risk.
Patients were hospitalized for a me-
dian of six days (range = 4-10 days), and
patient characteristics and reasons for
hospital admission (most commonly non-
pulmonary infection and acute stroke)
were similar between each group.
The e-alert system pop-up screen
first asked the physician to complete the
Geneva Risk Score. The system permit-
ted physicians to postpone this action
three times (an allowance to help increase
compliance); once the physician agreed
to calculate the Geneva Risk Score, the
system generated the total.
If the risk score was ≥3 points, the
e-alert system informed the physician that
thromboprophylaxis was indicated, listing
detailed recommendations for specific
anticoagulants (enoxaparin or unfraction-
ated heparin) or mechanical measures
(compression stockings or intermittent
pneumatic compression), depending on a
patient’s bleeding risk. Thromboprophy-
laxis was not indicated for patients with a
Geneva Risk Score <3 points.
Research nurses also reviewed patient
records to gather data on baseline demo-
graphics, comorbid conditions, laboratory