Improving the use of venous thromboembolism prophylaxis in an Australian teaching hospital.
BACKGROUND
Hospital-acquired venous thromboembolism (VTE) is a potentially fatal complication of hospitalisation, with meta-analyses and guidelines supporting the use of proven prophylactic measures (graduated compression stockings (GCS) and anticoagulants). Despite this, prophylaxis is underutilised and represents one of the largest gaps between evidence and current clinical practice.


METHODS
All episodes of VTE complicating hospitalisation were ascertained prospectively as part of a quality improvement programme over 3.5 years with a view to designing interventions to improve the use of prophylaxis and reduce the rate of VTE. Interventions initially centred upon highlighting the burden of VTE, the extent of failure to apply guideline evidence into practice, and the development and application of a hospital-wide risk assessment tool. Later interventions sought to build the risk-assessment tool into routine clinical care and enhanced feedback on VTE to clinical teams.


RESULTS
The annual rate of VTE fell in all the years following the intervention (2001), from 2.57 per 1000 cost-weighted separations to a nadir of 1.87 in 2003, with the difference being statistically significant (RR 0.68, 0.47 to 0.99, p = 0.04). The proportion of patients receiving anticoagulant prophylaxis increased (48% to 74%, p = 0.01) but there was no change in the measured use of GCS. There was a marked increase in the use of risk assessment for VTE in the ward setting (7.7% to 100%, p<0.001) during the programme.


CONCLUSIONS
Affordable and accessible interventions can improve the application of VTE prophylaxis guidelines into daily hospital care and are associated with reductions in this potentially life-threatening complication.
Gallagher
M
M
The George Institute for International Health, PO Box M201, Missenden Rd, Camperdown, NSW 2050, Australia. mgallagher@george.org.au
Oliver
K
K
Hurwitz
M
M
D000925:Anticoagulants / Q000627:therapeutic use*; D001315:Australia; D004305:Dose-Response Relationship, Drug; D019983:Guideline Adherence; D006493:Heparin / Q000627:therapeutic use*; D006760:Hospitalization; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D053828:Stockings, Compression / Q000706:statistics & numerical data*; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin