title: Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a common preventable cause of mortality in hospitalized medical patients. Despite rigorous randomized trials generating strong recommendations for anticoagulant use to prevent VTE, nearly 40% of medical patients receive inappropriate thromboprophylaxis. Knowledge-translation strategies are needed to bridge this gap.
  
  
  METHODS
  We conducted a 16-week pilot cluster randomized controlled trial (RCT) to determine the proportion of medical patients that were appropriately managed for thromboprophylaxis (according to the American College of Chest Physician guidelines) within 24 hours of admission, through the use of a multicomponent knowledge-translation intervention. Our primary goal was to determine the feasibility of conducting this study on a larger scale. The intervention comprised clinician education, a paper-based VTE risk assessment algorithm, printed physicians' orders, and audit and feedback sessions. Medical wards at six hospitals (representing clusters) in Ontario, Canada were included; three were randomized to the multicomponent intervention and three to usual care (i.e., no active strategies for thromboprophylaxis in place). Blinding was not used.
  
  
  RESULTS
  A total of 2,611 patients (1,154 in the intervention and 1,457 in the control group) were eligible and included in the analysis. This multicomponent intervention did not lead to a significant difference in appropriate VTE prophylaxis rates between intervention and control hospitals (appropriate management rate odds ratio = 0.80; 95% confidence interval: 0.50, 1.28; p = 0.36; intra-class correlation coefficient: 0.022), and thus was not considered feasible. Major barriers to effective knowledge translation were poor attendance by clinical staff at education and feedback sessions, difficulty locating preprinted orders, and lack of involvement by clinical and administrative leaders. We identified several factors that may increase uptake of a VTE prophylaxis strategy, including local champions, support from clinical and administrative leaders, mandatory use, and a simple, clinically relevant risk assessment tool.
  
  
  CONCLUSIONS
  Hospitals allocated to our multicomponent intervention did not have a higher rate of medical inpatients appropriately managed for thromboprophylaxis than did hospitals that were not allocated to this strategy.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada. mpai@mcmaster.ca
authors.forename: Menaka
authors.initials: M
authors.lastname: Pai
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Lloyd
authors.forename: Ji
authors.initials: J
authors.lastname: Cheng
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: R Brian
authors.initials: RB
authors.lastname: Haynes
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.forename: James D
authors.initials: JD
authors.lastname: Douketis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D004812:Epidemiologic Methods; D005260:Female; D019983:Guideline Adherence; D006493:Heparin / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000706:statistics & numerical data; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D054556:Venous Thromboembolism / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006493:Heparin