Innovative approaches to increase deep vein thrombosis prophylaxis rate resulting in a decrease in hospital-acquired deep vein thrombosis at a tertiary-care teaching hospital.
OBJECTIVE
Hospital-acquired venous thromboembolic events (VTEs) in medically ill patients account for a significant percentage of in-hospital mortality. Unfractionated heparin and low-molecular-weight heparin have been shown to be effective in the prevention of VTEs. However, use of these medications for thromboprophylaxis remains suboptimal. The objective of this article is to report the impact of a continuous quality improvement project on adherence with DVT prophylaxis guidelines and on the subsequent incidence of hospital-acquired DVT in medical patients at a teaching hospital between 2002 and 2005.


METHODS
In November 2002, Kings County Hospital Center Department of Medicine embarked on a project to increase the rate of thromboprophylaxis use. Quality improvement strategies included an active, multifaceted, layered combination of provider education, provider reminders with decision support, and audit with feedback.


RESULTS
The DVT prophylaxis rate on the general medicine house-staff service increased from a baseline of 63% in 2002 to 96% in 2005. The number of hospital-acquired DVTs decreased from a baseline of 14 in 2002 to 1 in 2005. The hospital-acquired DVT rate fell significantly, from 2.6 per 1000 discharges in 2002 (95% CI 1.5-4.4) to 0.2 per 1000 discharges in 2005 (95% CI 0.0-1.1), P = .007.


CONCLUSIONS
A layered combination of provider education, provider reminders with decision support, and audit with feedback increased the DVT prophylaxis rate and decreased the rate of hospital-acquired DVTs in the medicine department at a tertiary-care hospital center.
Bullock-Palmer
Renee P
RP
Kings County Hospital Center, State University of New York-Downstate Medical Center, Brooklyn, NY 11203, USA. renee.bullock@downstate.edu
Weiss
Steven
S
Hyman
Charles
C
D000328:Adult; D018890:Chemoprevention / Q000592:standards / Q000706:statistics & numerical data*; D003661:Decision Support Techniques; D004501:Education, Medical / Q000379:methods; D005246:Feedback; D019983:Guideline Adherence; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006784:Hospitals, Teaching / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008485:Medical Audit; D012308:Risk Management; D017749:Total Quality Management; D020246:Venous Thrombosis / Q000517:prevention & control*
D006495:Heparin, Low-Molecular-Weight