Can eliminating risk stratification improve medical residents' adherence to venous thromboembolism prophylaxis?
OBJECTIVE
Hospital-acquired venous thromboembolism (VTE) is a common and preventable adverse event that most patients are at risk of developing during their hospital stay. VTE prophylactic anticoagulation (chemoprophylaxis) is the preferred pharmacological assignment for reducing risk of VTE, but it is underused in current practices involving risk stratification (RS) for VTE prevention. The purpose of this study was to determine whether a protocol that eliminates the RS step (non-RS protocol) is more likely to lead residents to evidence-based VTE assignment than the currently used RS protocol. The non-RS protocol follows a methodology that reduces complexity by assuming that the risk of VTE is present and uses contraindications to determine appropriate VTE assignment.


METHODS
In 2009, 41 medicine residents at the Nebraska Western Iowa Veterans Affairs clinic participated in an online comparison of two different protocols (RS and non-RS) for assigning chemoprophylaxis for VTE. Six validated, hypothetical patient scenarios were used to compare appropriate (evidence-based) VTE assignments for VTE and completion times for each protocol.


RESULTS
Statistical analyses found that the non-RS protocol produced significantly faster (P < .001) scenario completion times and significantly more (P < .001) appropriate VTE assignments than the RS protocol for four of the six patient scenarios.


CONCLUSIONS
This study used a new, streamlined protocol (non-RS), which improved VTE assignment and the use of chemoprophylaxis and simplified the process when compared with the use of a traditional RS protocol.
Nebraska Western Iowa Veterans Affairs Health Care System and Division of General Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
Ann L
AL
Polich
Gale M
GM
Etherton
Jon T
JT
Knezevich
Justin B
JB
Rousek
Chris M
CM
Masek
M Susan
MS
Hallbeck
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000379:methods; D008297:Male; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000193:education*; D012016:Reference Values; D012308:Risk Management; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants