Prevention of perioperative venous thromboembolism and coronary events: differential responsiveness to an intervention program to improve guidelines adherence.
BACKGROUND
Prevention of venous thromboembolism and coronary events (with beta-blockers) during and after surgery is at the top of a list of safety practices for hospitalized patients, recommended by the Agency for Health Care Research and Quality (AHRQ). We wished to determine and improve adherence to clinical guidelines for these topics in our institution. PATIENTS, MATERIAL, AND METHODS: A prospective survey was conducted over several weeks on operated patients in a 1200-beds medical center (a teaching, community and referral hospital in Jerusalem, Israel). Eligibility for and actual administration of prophylactic treatment with anticoagulant and beta-blockers were determined. Following an intervention program, which included staff meetings, development of local protocols, and academic detailing by a nurse, the survey was repeated.


RESULTS
In general, adherence to recommended anticoagulation prophylaxis was low, found in only 29% [95% confidence interval (CI) = 23-36] of eligible patients. After the intervention, adequate anticoagulation increased to 50% (95% CI = 40-59) of eligible patients (P < 0.001). Initiation of beta-blockers in preventing perioperative cardiac events was very low (0%, 95% CI = 0-5%) and did not increase after intervention.


CONCLUSIONS
Adherence to guidelines for prevention of surgical complications was found to be low in our institution. A multifaceted intervention significantly increased use of prophylaxis for venous thromboembolism but not for coronary events. This differential response suggests that the success of a quality improvement project strongly depends on topic content and its phase of acceptance.
Grupper
A
A
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Grupper
A
A
Rudin
D
D
Drenger
B
B
Varon
D
D
Gilon
D
D
Gielchinsky
Y
Y
Menashe
M
M
Mintz
Y
Y
Rivkind
A
A
Brezis
M
M
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D018890:Chemoprevention; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D007557:Israel; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D011183:Postoperative Complications / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D013923:Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000517:prevention & control*
D000319:Adrenergic beta-Antagonists