Effect of time of admission on compliance with deep vein thrombosis prophylaxis in a tertiary medical intensive care unit

Abstract

Summary. Objective: We sought to evaluate deep vein thrombosis (DVT) prophylaxis compliance according to time of admission in a medical intensive care unit (MICU). Methods: This was a retrospective cohort study at a closed tertiary MICU. We classified patients into three groups (week days, weekends, and week nights), according to time of admission. An unweighted risk factor score (RFS) was calculated from 20 known risk factors. We defined DVT prophylaxis compliance as any type of prophylaxis (mechanical or pharmacologic) for RFS £ 3 or both types of prophylaxis for RFS > 3. Noncompliance was defined as no prophylaxis or single-type prophylaxis for RFS > 3. Results: We analyzed 105 admissions. Eighty (76.19%) patients received compliant DVT prophylaxis, and 25 (23.81%) patients received non-compliant regimens of whom 11 (10.48%) were not on any prophylaxis. DVT prophylaxis compliance was not different across the three admission groups. The non-compliant DVT prophylaxis group had a higher RFS (3.48 ± 2.1 vs. 2.25 ± 1.5; P = 0.011), a trend towards fewer female patients (40% vs. 60%; P = 0.079), and a higher percentage of admissions by interns at the first postgraduate year (PGY) level (28% vs. 5.4%; P = 0.01). Logistic regression revealed that only RFS and PGY level were independent predictors for compliance (P = 0.015 and 0.005 respectively). Time of admission was not a significant factor. Conclusions: Time of admission did not influence DVT prophylaxis compliance. Compliance improved with higher PGY level and lower RFS. A higher level of knowledge probably explains the association with PGY level; however, we cannot explain the inverse relationship between RFS and compliance.

Effect of the time of diagnosis on outcome in patients with acute venous thromboembolism

“…Weekends may be problematic for the diagnosis and management of some acute conditions requiring complex and multidisciplinary care, due to a lower availability of experienced staff and higher workload/staff ratio (9). Increased mortality among patients admitted on weekends has been found in patients with myocardial infarction or stroke (10,11) but not in those with heart failure, acute leukaemia, or admitted to intensive care units (12)(13)(14)(15)(16)(17). Our data reveal that patients with a VTE diagnosis established on weekends had similar clinical characteristics (severity of the VTE episode, frequency of underlying diseases) and received the same therapy (drugs, doses) than those in whom the VTE was detected on weekdays.…”