title: The use of an exclusion-based risk-assessment model for venous thrombosis improves uptake of appropriate thromboprophylaxis in hospitalized medical patients.
abstract: BACKGROUND
  Venous thromboembolism is a common condition in hospitalized medical patients. Numerous studies have demonstrated that low molecular weight heparin significantly reduces this risk but, despite this, the use of thromboprophylaxis remains poor.
  
  
  OBJECTIVE
  To evaluate the use of an exclusion based risk-assessment model (RAM) for venous thrombosis in improving the uptake of appropriate thromboprophylaxis in hospitalized medical patients.
  
  
  METHODS
  A survey with a subsequent audit cycle of three separate audits over 36 months.
  
  
  METHODS
  497 hospitalized patients with acute medical conditions on general medical wards were audited at a secondary care centre in London, UK. The survey and subsequent audits were performed by reviewing the notes and medication charts of medical patients, prior to the launch of the RAM and at 12, 28 and 36 months following its introduction.
  
  
  RESULTS
  Prior to launching the RAM, 49% of hospitalized medical patients received appropriate thromboprophylaxis. This did not change 12 months after the RAM was introduced but increased significantly to 71% following formal education of the health care professionals involved in thromboprophylaxis prescription. This improvement was maintained as demonstrated by a subsequent audit 8 months later (75.9%).
  
  
  CONCLUSIONS
  The introduction of a simple exclusion-based RAM for venous thrombosis in medical patients significantly improved delivery of thromboprophylaxis. The successful uptake of the RAM appears to have been dependent on direct education of those health carers involved in its use. A similar exclusion-based model used nationally could have a significant impact on the burden of VTE currently experienced in the UK.
authors.affiliation: Department of Haematology, 3rd Floor Macewen Building, Glasgow Royal Infirmary, Castle Street, Glasgow, G4 0SF, UK. catherine.bagot@ggc.scot.nhs.uk
authors.forename: C
authors.initials: C
authors.lastname: Bagot
authors.forename: S
authors.initials: S
authors.lastname: Gohil
authors.forename: R
authors.initials: R
authors.lastname: Perrott
authors.forename: S
authors.initials: S
authors.lastname: Barsam
authors.forename: R K
authors.initials: RK
authors.lastname: Patel
authors.forename: R
authors.initials: R
authors.lastname: Arya
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008131:London; D008875:Middle Aged; D008954:Models, Biological; D018570:Risk Assessment; D012307:Risk Factors; D013223:Statistics as Topic; D053828:Stockings, Compression; D054556:Venous Thromboembolism / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D006495:Heparin, Low-Molecular-Weight