Improved use of thromboprophylaxis for deep vein thrombosis following an educational intervention.
BACKGROUND
We evaluated venous thromboembolism (VTE) prophylaxis rates in hospitalized medical patients in a teaching hospital, the State University of New York-Downstate Medical Center-University Hospital of Brooklyn, before and after implementation of a multifaceted VTE prophylaxis quality improvement intervention that combined regular education, dissemination of a decision support tool, and regular audit-and-feedback to resident physicians.


METHODS
The charts of 312 hospitalized medical patients were retrospectively reviewed to assess baseline rates of appropriate VTE prophylaxis. Rates of appropriate VTE prophylaxis were then determined 12 and 18 months after implementation of the quality improvement intervention. Data collected included risk factors for VTE, contraindications to anticoagulant prophylaxis, type of VTE prophylaxis prescribed, and whether the prophylaxis was appropriate.


RESULTS
Most of the hospitalized medically ill patients had 3 or more risk factors for VTE. At baseline, the proportion of patients receiving any form of VTE prophylaxis, primarily unfractionated heparin, was 47%. The proportion of patients for whom a physician provided appropriate prophylaxis was 43%. After the intervention, the proportion of patients receiving prophylaxis significantly increased, to 86% at 12 months, and this level was maintained at 18 months. The rate of appropriate prophylaxis increased to 68% and 85% after 12 and 18 months, respectively.


CONCLUSIONS
The proportion of hospitalized medical patients receiving appropriate VTE prophylaxis as recommended by evidence-based guidelines can be increased significantly by combining regular education, a decision support tool, and regular audit-and-feedback.
Cohn
Steven L
SL
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA. steven.cohn@downstate.edu
Adekile
Ayoola
A
Mahabir
Vishal
V
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000075202:Contraindications; D003661:Decision Support Techniques; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D019983:Guideline Adherence; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants; D006493:Heparin