title: A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals.
abstract: OBJECTIVE
  To assess the effectiveness of different strategies for increasing the uptake of prophylaxis for venous thromboembolism (VTE) in hospitalized patients through a systematic review of the literature.
  
  
  METHODS
  Literature databases and the Internet were searched from 1996 to May 2003. Studies of strategies to improve VTE prophylaxis practice were included. Studies where no policy or guideline was implemented or where the focus of the study was not VTE prevention were excluded.
  
  
  RESULTS
  Thirty studies were included. The quality of the available evidence was average with the majority of studies being uncontrolled before and after design and thus limited by the historical nature of much of the available data. Adherence to guidelines and the provision of adequate prophylaxis were poor in studies which relied on passive dissemination of guidelines. In general, the use of multiple strategies was more effective than a single strategy used in isolation. The most effective strategies incorporated a system for reminding clinicians to assess patients for VTE risk, either electronic decision-support systems or paper-based reminders, and used audit and feedback to facilitate the iterative refinement of the intervention. There were no studies adequately powered to demonstrate a reduction in rates of VTE. Insufficient evidence was available to make useful comparisons of strategies in terms of costs and resource utilization.
  
  
  CONCLUSIONS
  Passive dissemination of guidelines is unlikely to improve VTE prophylaxis practice. A number of active strategies used together, which incorporate some method for reminding clinicians to assess patients for DVT risk and assisting the selection of appropriate prophylaxis, are likely to result in the achievement of optimal outcomes.
authors.affiliation: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, South Australia, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tooher
authors.forename: Philippa
authors.initials: P
authors.lastname: Middleton
authors.forename: Clarabelle
authors.initials: C
authors.lastname: Pham
authors.forename: Robert
authors.initials: R
authors.lastname: Fitridge
authors.forename: Siohban
authors.initials: S
authors.lastname: Rowe
authors.forename: Wendy
authors.initials: W
authors.lastname: Babidge
authors.forename: Guy
authors.initials: G
authors.lastname: Maddern
mesh_terms: D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000517:prevention & control*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control*
references.citation: Chest. 2001 Dec;120(6):1964-71
references.pmid: 11742929
references.citation: J Obstet Gynaecol. 2001 Mar;21(2):138-40
references.pmid: 12521881
references.citation: Ann R Coll Surg Engl. 1997 Jan;79(1):55-7
references.pmid: 9038497
references.citation: Ann R Coll Surg Engl. 1998 Jan;80(1):55-7
references.pmid: 9579129
references.citation: J Clin Pharm Ther. 1999 Aug;24(4):279-87
references.pmid: 10475986
references.citation: Haematologica. 2002 Jul;87(7):746-50; discussion 250
references.pmid: 12091126
references.citation: Ann Surg. 1999 Nov;230(5):728-33
references.pmid: 10561099
references.citation: Ann R Coll Surg Engl. 2000 Jan;82(1):69-70
references.pmid: 10700773
references.citation: Orthop Nurs. 2000 May-Jun;19(3):73-8
references.pmid: 11153336
references.citation: Arch Intern Med. 1994 Mar 28;154(6):669-77
references.pmid: 8129501
references.citation: Can J Surg. 2002 Feb;45(1):47-52
references.pmid: 11837921
references.citation: Health Bull (Edinb). 1999 Mar;57(2):141-7
references.pmid: 12828138
references.citation: Ann R Coll Surg Engl. 1996 Jul;78(4):345-9
references.pmid: 8712648
references.citation: Postgrad Med J. 2000 Jun;76(896):354-6
references.pmid: 10824050
references.citation: JAMA. 2000 Jun 7;283(21):2816-21
references.pmid: 10838650
references.citation: JAMA. 1986 Aug 8;256(6):744-9
references.pmid: 3723773
references.citation: J Eval Clin Pract. 1998 May;4(2):113-7
references.pmid: 9839637
references.citation: Chest. 1992 Oct;102(4 Suppl):391S-407S
references.pmid: 1395824
references.citation: Int Angiol. 2001 Mar;20(1):1-37
references.pmid: 11342993
references.citation: Clin Perform Qual Health Care. 2000;8(2):72-82
references.pmid: 11184054
references.citation: BMJ. 1992 Sep 5;305(6853):567-74
references.pmid: 1298229
references.citation: J Trauma. 2002 Jul;53(1):142-64
references.pmid: 12131409
references.citation: Scott Med J. 1998 Feb;43(1):23-5
references.pmid: 9533256
references.citation: Proc AMIA Symp. 1998;:573-6
references.pmid: 9929284
references.citation: Arch Intern Med. 1998 Sep 28;158(17):1909-12
references.pmid: 9759687
references.citation: Therapie. 1998 Mar-Apr;53(2):101-6
references.pmid: 9773108
references.citation: Ann R Coll Surg Engl. 1998 Sep;80(5):347-9
references.pmid: 9849337
references.citation: Chest. 1998 Jan;113(1):162-4
references.pmid: 9440584
references.citation: Pharmacotherapy. 2001 Jun;21(6):740-7
references.pmid: 11401186
references.citation: Chest. 2001 Jan;119(1 Suppl):1S-2S
references.pmid: 11157638
references.citation: J R Coll Surg Edinb. 2001 Dec;46(6):329-33
references.pmid: 11768571
references.citation: BMJ. 1996 Oct 12;313(7062):917
references.pmid: 8876095
references.citation: Chest. 1995 Oct;108(4 Suppl):312S-334S
references.pmid: 7555186
references.citation: J Bone Joint Surg Am. 2000 Jul;82-A(7):929-38
references.pmid: 10901307
references.citation: J Am Coll Surg. 1999 Dec;189(6):533-8
references.pmid: 10589588
references.citation: J Mal Vasc. 1998 Oct;23(4):257-62
references.pmid: 9827404
references.citation: J Trauma. 2003 Feb;54(2):232-5
references.pmid: 12579045
references.citation: Arch Intern Med. 2000 Feb 14;160(3):334-40
references.pmid: 10668835
references.citation: ANZ J Surg. 2002 May;72(5):331-4
references.pmid: 12028089