Validation of a clinical guideline on prevention of venous thromboembolism in medical inpatients: a before-and-after study with systematic ultrasound examination.
BACKGROUND
Clinical practice guidelines on prevention of venous thromboembolism in medical inpatients have been implemented in various settings, although few studies have assessed their impact on venous thromboembolism events.


OBJECTIVE
To determine whether the implementation of a locally developed guideline is followed by changes in the rate of deep vein thrombosis.


METHODS
A before-and-after study consisting in two "1-day" cross-sectional studies.


METHODS
Thirteen adult medical wards in a teaching hospital in France.


METHODS
All the patients hospitalized on the day of the cross-sectional study.


METHODS
A clinical guideline integrating scientific evidence and data on target medical providers' practices was developed by a local expert panel and implemented through a multifaceted intervention.


METHODS
Prevalence of deep vein thrombosis detected by systematic ultrasound examination.


RESULTS
The study included 338 patients in the preintervention sample and 340 in the postintervention sample. The prevalence of deep vein thrombosis decreased from 9.5% (95% CI, 6.6-13.1) in the preintervention sample to 3.2% (95% CI, 1.6-5.7) in the postintervention sample (P < 0.01). The decrease in the rate of thrombosis involved all deep veins of the lower limbs and remained significant after adjustment for risk factors (adjusted odds ratio = 0.47, 95% CI, 0.32-0.70). No additional cases of pulmonary embolism or deep vein thrombosis were reported either on the day of the study or in the following 2 days.


CONCLUSIONS
Active implementation of a clinical practice guideline directed at medical providers (doctors, nurses and physical therapists) can be followed by a significant decrease in prevalence of deep vein thrombosis.
Labarere
J
J
Unite d'Evaluation Medicale, Pavillon D, Centre Hospitalier Universitaire de Grenoble, 38-043 Grenoble Cedex 9, France. jlabarere@chu-grenoble.fr
Bosson
J-L
JL
Brion
J-P
JP
Fabre
M
M
Imbert
B
B
Carpentier
P
P
Pernod
G
G
D000368:Aged; D001458:Bandages; D003430:Cross-Sectional Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control; D012307:Risk Factors; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight