title: Follow-up after four-year quality improvement program to prevent inferior limb deep vein thrombosis in intensive care unit.
abstract: BACKGROUND
  Deep vein thrombosis (DVT) is a life-threatening complication in intensive care unit (ICU) patients and DVT incidence is used as a marker of quality care. In our ICU an educational program for implementation of DVT prophylaxis and ultrasound screening resulted in a remarkable decrease in DVT incidence which fell from 11.6% to 4.7%. The aim of this paper is to investigate a 4-year long persistent quality improvement of DVT prophylaxis obtained through the implementation of our educational intervention.
  
  
  METHODS
  The study was composed of three phases: after the first retrospective investigation of DVT incidence and the evidence of the efficacy of the educational program, this third phase investigates the 2-year long sustainability and persistence in the fall of DVT incidence by the adoption of 1) an electronic form for DVT prophylaxis prescription, 2) a nursing protocol for the application of elastic stokes and 3) a personalized form with a check-list dedicated to DVT prophylaxis. Ultrasound DVT screening was performed twice a week by ICU clinicians.
  
  
  RESULTS
  The application of DVT prophylaxis was associated with a very low incidence of DVT (2.6%) not entirely attributable to changes in characteristics of enrolled patients and/or to less intensive DVT ultrasound screening when compared to the preceding phases. Mean mechanical ventilation duration and ICU length of stay were short and similar to those of the second phase and ICU mortality did not change.
  
  
  CONCLUSIONS
  The direct involvement of ICU clinicians and nurses in the application of DVT prophylaxis and in DVT diagnosis markedly contributed to maintain a low DVT incidence over time, despite the high turnover of patients.
authors.affiliation: Department of Critical Care Medicine and Surgery, Careggi Teaching Hospital, Largo Brambilla 3, I-50139, Florence, Italy. Electronic address: maria.boddi@unifi.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Boddi
authors.affiliation: Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cecchi
authors.affiliation: Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Bonizzoli
authors.affiliation: Postgraduate School of Anaesthesia and Intensive Care, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Barbani
authors.affiliation: Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Franci
authors.affiliation: Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Anichini
authors.affiliation: Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Batacchi
authors.affiliation: Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy.
authors.forename: Jessyca
authors.initials: J
authors.lastname: Parodo
authors.affiliation: Department of Critical Care Medicine and Surgery, Careggi Teaching Hospital, Largo Brambilla 3, I-50139, Florence, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
mesh_terms: D001291:Attitude of Health Personnel; D057189:Checklist; D002983:Clinical Competence; D016303:Clinical Pharmacy Information Systems; D055695:Electronic Prescribing; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007318:Inservice Training; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D035002:Lower Extremity / Q000098:blood supply*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents
keywords: Critical care; Deep vein thrombosis; Intensive care unit; Ultrasound