Implementation of the NICE Guidelines for Venous Thromboprophylaxis; A National Survey of Hip Surgeons

Sharif, Khalid; Rehman, S; Nunn, Timothy; Bagga, T K

doi:10.1177/112070000901900111

Cited by 8 publications

(9 citation statements)

References 25 publications

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“…Expert investigators and societies [including the American College of Chest Physicians (ACCP)] in the field of thromboprophylaxis were also contacted to inquire about available questionnaires evaluating the knowledge of physicians about VTE prophylaxis. Ultimately, a few valuable questionnaires were located [11][12][13][14][15][16][17][18]. However, contrary to topics such as cardiopulmonary resuscitation for which validated questionnaires exist to evaluate the physicians' knowledge of the guideline recommendations [19], it became evident that none of the located questionnaires [11][12][13][14][15][16][17][18] were developed in a systematic way to comprise the majority of issues about VTE prophylaxis, even for a specialty setting.…”

Section: Questionnaire Preparationmentioning

confidence: 99%

“…A few questionnaires do exist that address the knowledge of physicians about various thromboprophylaxis issues [11][12][13][14][15][16][17][18]. Interestingly, some of such questionnaires used 'case vignettes' as their main body of questions in order to evaluate the physicians' knowledge in a setting similar to their real-world everyday practice [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, some of such questionnaires used 'case vignettes' as their main body of questions in order to evaluate the physicians' knowledge in a setting similar to their real-world everyday practice [11][12][13][14][15][16]. Most of such questionnaires, however, are not systematically developed and evaluate only a minority of issues regarding thromboprophylaxis, even in specialty settings.…”

Section: Introductionmentioning

confidence: 99%

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Chest physicians’ knowledge of appropriate thromboprophylaxis

Bikdeli

Kashani²,

Raeissi³

et al. 2011

Blood Coagulation &Amp; Fibrinolysis

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Venous thromboembolism (VTE) is a major cause of in-hospital mortality. Several international guidelines provide thromboprophylaxis recommendations; however, guidelines adherence is missing worldwide. We evaluated the chest physicians' knowledge regarding VTE prophylaxis, using a systematically developed questionnaire. The Prophylaxis-foR-venOus-throMbOembolism-assessmenT-questionnairE (PROMOTE) questionnaire was developed using an algorithm encompassing the most important VTE prophylaxis topics and included 13 clinical scenarios. Responses were evaluated with reference to the eighth edition of American College of Chest Physicians guidelines for VTE prevention to assess thromboprophylaxis appropriateness. The questionnaires were distributed during the fourth International Congress on Pulmonary Disease, Intensive Care and Tuberculosis. From the 88 received questionnaires (response rate: 39.8%), 82 were acceptable (62 men, 20 women). The most commonly cited VTE risk factors were immobility (79.2%), surgery (68.2%), and cancer (60.9%). The mean correct response ratio to the questions was 67% [95% confidence interval (CI) 64-70%] with highest appropriateness ratios amongst cardiologists (77.1 ± 5.8%) and lowest ratios among thoracic surgeons (59.2 ± 5%). Physicians' specialty had a significant effect on the overall appropriateness (P = 0.04) and most of appropriateness subcategories. Thoracic surgeons had the lowest rate of over-prophylaxis (P = 0.02). Years passed from graduation were inversely associated with overall appropriateness (P = 0.006). Physicians with academic engagements had a higher overall appropriateness (P = 0.04). We found a wide gap between the guideline recommendations and the responses. PROMOTE is the first systematically developed questionnaire that addresses chest physicians' thromboprophylaxis knowledge and could be useful to strategies to improve VTE prophylaxis. Because of the dissimilar prophylaxis pitfalls of different specialists, distinct educational programs seem necessary to improve their knowledge of proper VTE prophylaxis.

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Section: Questionnaire Preparationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Chest physicians’ knowledge of appropriate thromboprophylaxis

Bikdeli

Kashani²,

Raeissi³

et al. 2011

Blood Coagulation &Amp; Fibrinolysis

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show abstract

“…180 Nevertheless, in 2011 Duff et al reported that the following factors were identified as barriers to thromboprophylaxis guideline uptake in a metropolitan Sydney hospital: A lack of motivation to change, a lack of systems support, a knowledge or awareness deficit and disputed evidence.…”

mentioning

confidence: 99%

Thromboprophylaxis following hip and knee arthroplasty

Mirkazemi

Bereznicki

Peterson

2013

Internal Medicine Journal

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Aim To determine local thromboprophylaxis prescribing practices following arthroplasty. Methods A retrospective review was performed of 300 consecutive hip and knee arthroplasty patients (150 each) over a 2‐year period at Tasmania's major public hospital. The provision of thromboprophylaxis, the presence of bleeding/thrombotic risk factors and the prevalence of symptomatic venous thromboembolism (VTE) and major bleeding occurring within 90 days postoperatively were documented. Results The mean age of the 300 patients (169 females, 131 males) was 68.7 years (standard deviation 10.4). Only 11.3% of knee arthroplasty and 16.7% of hip arthroplasty inpatients had mechanical thromboprophylaxis documented during their stay. All inpatients received pharmacological thromboprophylaxis, predominantly injectable anticoagulants (98.4%). Only 36.5% continued to receive pharmacological thromboprophylaxis following discharge, predominantly an antiplatelet agent (55.5%). The 90‐day incidence of symptomatic VTE was 2.7% (95% confidence interval: 1.0–5.0%); 4.0% (95% confidence interval: 1.0–8.0%) for knees and 1.3% (95% confidence interval: 0–5.0%) for hips. The in‐hospital and post‐discharge VTE incidence was 0.7% and 2.0% respectively. All readmissions for VTE occurred within 1 month of surgery. Conclusions While inpatient thromboprophylaxis was routine, it generally was not continued on discharge, potentially leaving many patients exposed to a higher risk of VTE. Most cases of symptomatic VTE occurred after discharge, with the majority requiring readmission to hospital under medical units.Within the limitations of a retrospective study, these findings suggest a need for further research and discussion regarding what constitutes appropriate thromboprophylaxis (type, agent and duration) following hip or knee arthroplasty.

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“…A retrospective study by Yu et al [8] found that the overall compliance with (ACCP) guidelines for the prevention of VTE in six American hospitals was only 13.3%, ranging from 2.8% for neurosurgery to 52.4% for orthopaedic surgery. A survey amongst surgeons in the United Kingdom by Sharif et al [9] showed that only 7% of respondents were adhering to NICE guidance after hip fracture surgery and 44% after hip arthroplasty.…”

mentioning

confidence: 99%