Improving uptake of prophylaxis for venous thromboembolism in general surgical patients using prospective audit

Association Between Inpatient Surveillance and Venous Thromboembolism Rates After Hospital Discharge

“…17,18 Our study, which assessed surveillance and outcomes in the same surgical population for each hospital, did find a positive association between the use of surveillance tests and VTE outcomes using VASQIP-assessed events. Several studies [19][20][21] have been published on individual hospital VTE prevention strategies with subsequent improvement in VTE outcomes, whereas increased SCIP-VTE adherence has not been shown to be associated with decreased VTE rates. 13,15 The lack of robustness for the SCIP-VTE measures likely explains the lack of improved VTE outcomes despite high adherence rates.…”

“…Successful reductions in hospital VTE rates have been achieved by focusing on risk stratification and an appropriate duration of VTE prophylactic measures that are not limited to prophylaxis alone. [19][20][21] This scenario suggests that the definition for SCIP-VTE adherence should be expanded beyond the initial 24 hours after surgery if it is to be a useful quality measure. Perhaps, a threshold proportion of hospital days covered by VTE prophylaxis (eg, ≥80%) would be a more informative measure of hospital quality regarding VTE prevention.…”

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

“…8,11 A combined strategy should help physicians remember to assess the VTE risk status of patients, and assist them in prescribing appropriate prophylaxis. 8 Byrne et al 31 found it was by using a combination of a more accessible assessment sheet and asking the nursing staff to provide reminders that considerable improvement in the provision of prophylaxis was achieved. As indicated in Table 4, QI strategies are not time-consuming 27 and require only a few hours a month of health care workers' time.…”

“…31 After the introduction of a risk-factor assessment sheet, a second audit showed that only 37% of patients had a completed risk-assessment sheet, and only 54% (of 59 patients) had received appropriate prophylaxis. This prompted the authors to make the assessment sheet more accessible (by using a scaled-down version on the reverse of a standard prescription sheet), and to initiate a reminder system that required nursing staff to make regular checks for completion.…”

“…However, the forms should be readily accessible, and a system of checks and follow-up should exist to ensure that they are completed; this is crucial during the form introduction phase. 31,32 For example, during the introduction of risk-factor assessment-protocol sheets in a UK surgical department, only a third of forms were completed. After completion checking by nursing staff was initiated, 96% of the forms were completed, 32 emphasizing that an active attitude is the key to QI initiative success.…”