A Systematic Review of Strategies to Improve Prophylaxis for Venous Thromboembolism in Hospitals

Tooher, Rebecca; Middleton, Philippa; Pham, Clarabelle T.; Fitridge, Robert; Rowe, Siohban; Babidge, Wendy; Maddern, Guy J.

doi:10.1097/01.sla.0000154120.96169.99

Cited by 256 publications

(250 citation statements)

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“…A systematic review by Tooher et al 8 including studies published between 1996 and May 2003 was used as a basis to identify studies on QI strategies for VTE prevention. Additional studies between May 2003 and May 2006 were identified with multiple MEDLINE searches.…”

Section: Qi Strategies For Vte Prevention Methods Of Literature Reviewmentioning

confidence: 99%

“…20 This program involved presentations to staff, posters placed around the hospital, dissemination of baseline results, and the distribution of a card summarizing the guidelines. Several studies have investigated the use of active strategies and a recent systematic review by Tooher et al 8 included such studies from 1996 to May 2003, (Fig. 1).…”

Section: Active Qi Strategiesmentioning

confidence: 99%

“…8,[17][18][19] A recent review cited 6 studies that relied on the passive dissemination of guidelines to change VTE prophylaxis-no more than half of the patients received appropriate prophylaxis. 8 For example, a study of 1,128 hospitalized medical patients in 2 UK hospitals found that a presentation of international guidelines to hospital staff did not increase prophylaxis rates (28% versus 31% after presentation, P=.59). 19 However, dissemination of guidelines as part of an active strategy does improve their implementation.…”

Section: Active Qi Strategiesmentioning

confidence: 99%

“…5,7 However, passive dissemination of such guidelines does not ensure that patients who are at risk receive the prophylaxis they need, or that patients are given appropriate prophylaxis. 8 A study in 2001 found that of 2,367,362 medically ill patients who had ACCP-defined indications for prophylaxis in 330 hospitals across the US, only 26% had been given prophylaxis. This low prophylaxis rate has not significantly improved, as the prophylaxis rate was 33% in 2004.…”

Section: Introductionmentioning

confidence: 99%

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Bridging the Gap Between Evidence and Practice in Venous Thromboembolism Prophylaxis: The Quality Improvement Process

Michota

2007

J GEN INTERN MED

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Venous thromboembolism (VTE) is considered to be the most common preventable cause of hospital-related death. Hospitalized patients undergoing major Surgery and hospitalized patients with acute medical illness have an increased risk of VTE. Although there is overwhelming evidence for the need and efficacy of VTE prophylaxis in patients at risk, only about a third of those who are at risk of VTE receive appropriate prophylaxis. To address the shortfall in VTE prophylaxis, the US Joint Commission and the National Quality Forum (NQF) endorse standardized VTE prophylaxis practices, and are identifying and testing measures to monitor these standards. Hospitals in the USA accredited by Centers for Medicare and Medicaid Services to receive medicare patients will need VTE prophylaxis programs in place to conform to these national consensus standards. This review aims to give background information on initiatives to improve the prevention of VTE and to identify key features of a successful quality improvement strategy for prevention of VTE in the hospital. A literature review shows that the key features of effective quality improvement strategies includes an active strategy, a multifaceted approach, and a continuous iterative process of audit and feedback. Risk assessment models may be helpful for deciding which patients should receive prophylaxis and for matching VTE risk with the appropriate intensity of prophylaxis. This approach should assist in implementing the NQF/Joint Commission-endorsed standards, as well as increase the use of appropriate VTE prophylaxis.

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Section: Qi Strategies For Vte Prevention Methods Of Literature Reviewmentioning

confidence: 99%

Section: Active Qi Strategiesmentioning

confidence: 99%

Section: Active Qi Strategiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bridging the Gap Between Evidence and Practice in Venous Thromboembolism Prophylaxis: The Quality Improvement Process

Michota

2007

J GEN INTERN MED

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“…A presumed barrier for adherence to any VTE protocol is the complexity involved in performing individualized risk assessments. [8][9][10] All VTE prophylaxis strategies require the clinician to risk-stratify each patient, identify contraindications to a prophylaxis strategy, and select an accepted strategy. While many VTE risk assessment protocols exist, they tend to fall into two categories: 1) a point-based system, and 2) a simplified tiered system.…”

mentioning

confidence: 99%

Reliability of a point‐based VTE risk assessment tool in the hands of medical residents

Beck

Haidet

Todoric

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Venous thromboembolic events (VTE) are a significant cause of mortality in hospitalized medical and surgical patients. Despite recommendations and guidelines, current evidence demonstrates that VTE prophylaxis remains underutilized in at‐risk patients. The process of providing VTE prophylaxis begins with assessing each patient's VTE risk. Using an individualized, point‐based protocol in the assessment process is a complex task, and might contribute to variability in VTE prescribing behavior. There are no published data on how reliably residents can perform risk assessment and prophylaxis using a point‐based VTE risk assessment tool.OBJECTIVE:Our aim was to determine inter‐rater reliability of a point‐based risk assessment tool by residents early in the academic year.DESIGN:The design was a cross‐sectional‐cohort observational study.SETTING:The site was an academic medical center.PATIENTS:Case‐based clinical vignettes were used.INTERVENTIONS:Verbal instructions were given to medical residents about how to apply our hospital's point‐based VTE risk assessment tool.MEASUREMENTS:Interobserver agreement was measured of: 1) risk score, 2) risk‐stratification, 3) identification of contraindications, 4) VTE prophylaxis plan, and 5) resident adherence to the protocol.RESULTS:The intra‐class correlation (ICC) for the total risk score was 0.66 and the kappa coefficient for risk stratification was 0.51. The kappa scores for absolute and relative contraindications were 0.29 and 0.23, respectively. The kappa score for the VTE plan was 0.28.CONCLUSIONS:We determined that, following brief instructions early in the academic year, a point‐based VTE risk assessment tool has only fair to moderate inter‐rater reliability, with suboptimal adherence to the protocol. Both might lead to underutilization of VTE prevention strategies. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.

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Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

et al. 2012

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Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients.

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A Systematic Review of Strategies to Improve Prophylaxis for Venous Thromboembolism in Hospitals

Cited by 256 publications

References 33 publications

Bridging the Gap Between Evidence and Practice in Venous Thromboembolism Prophylaxis: The Quality Improvement Process

Bridging the Gap Between Evidence and Practice in Venous Thromboembolism Prophylaxis: The Quality Improvement Process

Reliability of a point‐based VTE risk assessment tool in the hands of medical residents

Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

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