title: Scorecard implementation improves identification of postpartum patients at risk for venous thromboembolism.
abstract: OBJECTIVE
  To evaluate if an intensive educational intervention in the use of a standardized venous thromboembolism (VTE) risk assessment tool (scorecard) improves physicians' identification and chemoprophylaxis of postpartum patients at risk for VTE.
  
  
  METHODS
  After implementation of a VTE scorecard and prior to an intensive educational intervention, postpartum patients (n = 140) were evaluated to assess scorecard completion, risk factors, and chemoprophylaxis. A performance improvement campaign focusing on patient safety, VTE prevention, and scorecard utilization was then conducted. Evaluation of the same parameters was subsequently performed for a similar group of patients (n = 133). Differences in scorecard utilization and risk assessment were tested for statistical significance.
  
  
  RESULTS
  Population-at-risk rates were similar in both assessment periods (31.4% vs 28.6%; p = NS). The greatest risk factors included cesarean delivery, body mass index (BMI) >30 and age >35. Scorecard completion rates for all patients increased in the postintervention period (15.7% vs 67.7%; p < .001). Postintervention scorecard completion rates for the at-risk population also improved (20% vs 79%; p < .001). In the postintervention group, those at risk with completed scorecards had higher prophylaxis rates than those at risk without scorecards (73% vs 25%; p = .03). At-risk patients with completed scorecards had 2.6 times more orders for chemoprophylaxis than at-risk patients without scorecards in both time periods (odds ratio [OR] = 8.4; 95% confidence interval [CI] 3.1-22.8).
  
  
  CONCLUSIONS
  Utilization of a VTE scorecard coupled with an educational intervention for health care providers increases detection and chemoprophylaxis orders for at-risk patients. Encouraging universal scorecard assessment standardizes identification and chemoprophylaxis of at-risk patients who were otherwise not perceived to be at risk.
authors.affiliation: Johns Hopkins School of Medicine.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Berkin
authors.affiliation: Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center.
authors.forename: Colleen
authors.initials: C
authors.lastname: Lee
authors.affiliation: Department of Clinical Obstetrics & Gynecology, Albert Einstein College of Medicine/Montefiore Medical Center.
authors.forename: Ellen
authors.initials: E
authors.lastname: Landsberger
authors.affiliation: Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chazotte
authors.affiliation: Division of Maternal Fetal Medicine and Clinical Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Bernstein
authors.affiliation: Women's Health in Obstetrics and Gynecology, Columbia University Medical Center.|Morgan Stanley Children's Hospital & Sloane Hospital for Women ,New York-Presbyterian Hospital and Columbia University Medical Center.
authors.forename: Dena
authors.initials: D
authors.lastname: Goffman
mesh_terms: D019985:Benchmarking; D005260:Female; D006801:Humans; D049590:Postpartum Period; D058996:Quality Improvement; D012308:Risk Management; D054556:Venous Thromboembolism / Q000517:prevention & control*