title: Individualized Performance Feedback to Surgical Residents Improves Appropriate Venous Thromboembolism Prophylaxis Prescription and Reduces Potentially Preventable VTE: A Prospective Cohort Study.
abstract: OBJECTIVE
  To investigate the effect of providing personal clinical effectiveness performance feedback to general surgery residents regarding prescription of appropriate venous thromboembolism (VTE) prophylaxis.
  
  
  BACKGROUND
  Residents are frequently charged with prescribing medications for patients, including VTE prophylaxis, but rarely receive individual performance feedback regarding these practice habits.
  
  
  METHODS
  This prospective cohort study at the Johns Hopkins Hospital compared outcomes across 3 study periods: (1) baseline, (2) scorecard alone, and (3) scorecard plus coaching. All general surgery residents (n = 49) and surgical patients (n = 2420) for whom residents wrote admission orders during the first 9 months of the 2013-2014 academic year were included. Outcomes included the proportions of patients prescribed appropriate VTE prophylaxis, patients with preventable VTE, and residents prescribing appropriate VTE prophylaxis for every patient, and results from the Accreditation Council for Graduate Medical Education resident survey.
  
  
  RESULTS
  At baseline, 89.4% of patients were prescribed appropriate VTE prophylaxis and only 45% of residents prescribed appropriate prophylaxis for every patient. During the scorecard period, appropriate VTE prophylaxis prescription significantly increased to 95.4% (P < 0.001). For the scorecard plus coaching period, significantly more residents prescribed appropriate prophylaxis for every patient (78% vs 45%, P = 0.0017). Preventable VTE was eliminated in both intervention periods (0% vs 0.35%, P = 0.046). After providing feedback, significantly more residents reported receiving data about practice habits on the Accreditation Council for Graduate Medical Education resident survey (87% vs 38%, P < 0.001).
  
  
  CONCLUSIONS
  Providing personal clinical effectiveness feedback including data and peer-to-peer coaching improves resident performance, and results in a significant reduction in harm for patients.
authors.affiliation: *Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD†Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD§Armstrong Institute for Patient Safety and Quality¶Department of Surgery, University of Pennsylvania, Philadelphia, PA||The Armstrong Institute for Patient Safety, Johns Hopkins University School of Medicine, Baltimore, MD**Department of Medicine at the Johns Hopkins University School of Medicine††Department of Pharmacy at the Johns Hopkins Hospital‡‡Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD§§Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Brandyn D
authors.initials: BD
authors.lastname: Lau
authors.forename: George J
authors.initials: GJ
authors.lastname: Arnaoutakis
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
authors.forename: Isaac W
authors.initials: IW
authors.lastname: Howley
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Poruk
authors.forename: Robert
authors.initials: R
authors.lastname: Beaulieu
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Ellison
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Van Arendonk
authors.forename: Peggy S
authors.initials: PS
authors.lastname: Kraus
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Hobson
authors.forename: Christine G
authors.initials: CG
authors.lastname: Holzmueller
authors.forename: James H
authors.initials: JH
authors.lastname: Black
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
mesh_terms: D000328:Adult; D015142:Baltimore; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005246:Feedback; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010379:Peer Group; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000517:prevention & control*