title: [Optimizing the prophylaxis of hospital-acquired deep vein thrombosis and pulmonary thromboembolism].
abstract: OBJECTIVE
  To reduce the number of preventable hospital-acquired venous thromboembolic events (HA-VTE) and to improve the quality of VTE prophylaxis at multiprofile hospital.
  
  
  METHODS
  A comprehensive approach to preventing HA-VTE was developed, which involved the global trigger tool method to assess adverse events, as well as the computerized clinical decision support system (CDSS) to prevent HA-VTE on the basis of relevant clinical practice guidelines, and HA-VTE registry.
  
  
  RESULTS
  A total of 50 patients (15 men, 35 women; their median age was 70.5 years) with HA-VTE were included in the HA-VTE registry in January 2014 to June 2015. Assessment of a trend in the prevalence of HA-VTE when introducing CDSS to prevent VTE showed its statistically significant decline in the total number of HA-VTE cases (χ2=7.325, df=1; p=0.0068) and in that of HA-VTE in surgical patients (χ2=7.266, df=1; p=0.0070). The statistical significance of χ2 for linear trend was not achieved for medical patients, which is probably due to the small sample size (χ2=2.764, df=1; p=0.0964). While introducing CDSS, there was a statistically significant reduction in the incidence of postoperative VTE from 8.76 to 4.17 cases per 1000 interventions (χ2=5.347, df=1; p=0.0208; the absolute values of HA-VTE and surgical interventions were used for the calculation).
  
  
  CONCLUSIONS
  The proposed comprehensive approach can substantially increase the detection rate of HA-VTE and decrease its incidence rates. This requires a personified assessment of the risk of VTE and hemorrhage in all hospitalized patients on day 1 of their admission, timely initiation of recommended VTE prophylaxis, and dynamic assessment of the risk of VTE and hemorrhage for timely correction of the prophylaxis.
authors.affiliation: Medical Center, Bank of Russia, Moscow, Russia.
authors.forename: G I
authors.initials: GI
authors.lastname: Nazarenko
authors.affiliation: Medical Center, Bank of Russia, Moscow, Russia.
authors.forename: E B
authors.initials: EB
authors.lastname: Kleymenova
authors.affiliation: Medical Center, Bank of Russia, Moscow, Russia.
authors.forename: S A
authors.initials: SA
authors.lastname: Payushchik
authors.affiliation: Medical Center, Bank of Russia, Moscow, Russia.
authors.forename: V A
authors.initials: VA
authors.lastname: Otdelеnov
authors.affiliation: Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow, Russia.
authors.forename: D A
authors.initials: DA
authors.lastname: Sychev
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control; D015994:Incidence; D008297:Male; D011314:Preventive Health Services / Q000379:methods / Q000706:statistics & numerical data; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D058996:Quality Improvement; D018570:Risk Assessment / Q000379:methods; D012308:Risk Management / Q000458:organization & administration*; D012426:Russia / Q000453:epidemiology; D061665:Time-to-Treatment; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control