title: Evidence-based venous thromboembolism prophylaxis is associated with a six-fold decrease in numbers of symptomatic venous thromboembolisms in rehabilitation inpatients.
abstract: OBJECTIVE
  To measure the impact of a standardized risk assessment tool and specialty-specific, risk-adjusted venous thromboembolism (VTE) order sets on compliance with American College of Chest Physicians (ACCP) guidelines and the number of symptomatic VTE as assessed by administrative data.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Academic hospital inpatient rehabilitation unit.
  
  
  METHODS
  All patients on the rehabilitation unit.
  
  
  METHODS
  Assessment of VTE risk factors and evaluated admission VTE prophylaxis orders before and after implementation of an ACCP guideline-based, specialty-specific VTE risk assessment, and prophylaxis order set by using a standardized data collection form.
  
  
  METHODS
  Discharge diagnostic codes for VTE and pulmonary embolism were tracked by ICD-9 (International Classification of Diseases, 9th edition) discharge diagnosis codes for the 12 months before and 36 months after the intervention.
  
  
  RESULTS
  Before implementation of the VTE order set, 27% of patients received VTE prophylaxis in compliance with the 2004 ACCP VTE guidelines. By following implementation of specialty-specific, risk-adjusted VTE order sets, compliance increased to 98%. In the year before VTE order-set implementation, the number of VTEs per admission was 49 per 1000. By following implementation, the number of VTEs steadily decreased each year to 8 per 1000 in 2007 (χ(2) = 14.985; P = .0001).
  
  
  CONCLUSIONS
  Implementation of a standardized VTE risk assessment tool and prophylaxis order set resulted in a substantial improvement in compliance with ACCP guidelines for VTE prophylaxis and was associated with a 6-fold reduction in the number of symptomatic VTEs in a hospital-based rehabilitation unit.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21208, USA. rmayer2@jhmi.edu
authors.forename: R Samuel
authors.initials: RS
authors.lastname: Mayer
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Hobson
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Halpert
authors.forename: Sean M
authors.initials: SM
authors.lastname: Berenholtz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012047:Rehabilitation Centers; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*