title: Improving clinician performance of inpatient venous thromboembolism risk assessment and prophylaxis.
abstract: Clinicians are aware of the importance of thromboprophylaxis, and that the application of measures to prevent venous thromboembolism (VTE) occurrence in hospitalized patients must be improved. To enhance clinician execution of appropriate steps to reduce the risk of inpatient VTE, a performance improvement (PI) continuing medical education (CME) initiative consisting of 3 independent tracks for hospitalized patients-patients who are medically ill, patients receiving oncology treatment, and patients undergoing major orthopedic surgery-was designed and implemented. After a baseline chart review of select evidenced-based performance measures for VTE risk stratification and prevention, participants identified ≥ 1 area of personal improvement. Participants then engaged in a period of self-improvement and reassessed their performance with a second chart review. After participating in the PI CME activity, clinician participants in the medically ill track increased their documentation of VTE risk assessments upon patient admission from baseline (56% vs 93%, n = 250; P < 0.001) and their prescription of low-molecular-weight heparin, low-dose unfractionated heparin, or fondaparinux (72% vs 88%, n = 250; P < 0.001). Orthopedic-track participants were significantly more likely to prescribe 15 to 35 days of VTE prophylaxis after total hip arthroplasty or hip fracture surgery upon patient discharge compared with baseline (51%, n = 123 vs 61%, n = 107; P < 0.001). Oncology-track participants demonstrated a nonsignificant trend for assessing and documenting bleeding risk after participation in the PI CME activity (56% vs 68%, n = 80; P = 0.143). Improvements in evidence-based strategies to reduce the risk of inpatient VTE were associated with PI CME participation. Although areas for improvement remain, increased participant identification and use of prophylactic measures can reduce the risk of VTE in hospitalized patients.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Berry
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Stowell
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Gardner
mesh_terms: D000328:Adult; D004502:Education, Medical, Continuing; D019983:Guideline Adherence; D006764:Hospitals, Community; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D019637:Orthopedic Procedures; D019990:Perioperative Care; D058996:Quality Improvement; D018570:Risk Assessment; D014481:United States; D054556:Venous Thromboembolism / Q000517:prevention & control*