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

Michota, Franklin A.

doi:10.1007/s11606-007-0369-z

Cited by 92 publications

(66 citation statements)

References 35 publications

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“…In the absence of appropriate VTE prophylaxis, the reported incidence of VTE ranges from 10% to 40% in unselected hospitalized patients 1) . Not only is VTE the third most common cause of all hospitalrelated deaths 2) , it is also the most common preventable cause of hospital death 3) . Despite substantial evidence that VTE prophylaxis can reduce the incidence of VTE, prophylactic treatment remains largely underused in hospitalized patients [4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Validation of a Venous Thromboembolism Risk Assessment Model in Hospitalized Chinese Patients: A Case-Control Study

Zhou

Wang

et al. 2014

JAT

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Aim: The appropriate selection of hospitalized patients for venous thromboembolism (VTE) prophylaxis is an important unresolved issue. We sought to validate the Caprini model, a famous individual VTE risk assessment model (RAM), in hospitalized Chinese patients. Methods: We performed a retrospective case-control study among unselected hospitalized patients admitted to a comprehensive hospital in China. A total of 347 patients were confirmed to have VTE during hospitalization, and 651 controls were randomly selected to match the patients according to medical service. Both the patients and controls were retrospectively assessed for the risk of VTE using the Caprini RAM. Results: The average Caprini cumulative risk score in the patients was significantly higher than that observed in the controls (4.69±2.58 vs 3.16±1.82, p＜0.0001). Compared with that observed in the low-risk group, a classification of high-risk according to the Caprini model was associated with a 1.65-fold increased risk of VTE (95%CI 1.05-2.61), while that of highest-risk was associated with a 4.84-fold increased risk of VTE (95%CI 3.06-7.64). After further stratifying the highest risk level with a cumulative risk score of ≥ 5 into scores of 5-6, 7-8 and ≥ 9, the patients with a score of 5-6 were found to exhibit a 3.33-fold increased risk of VTE (95%CI 2.06-5.40), those with a score 7-8 exhibited a 9.41-fold increased risk of VTE (95%CI 4.90-18.08) and those with a score of ≥ 9 exhibited a 24.69-fold (95%CI 7.98-76.40) increased risk of VTE compared with their low-risk counterparts. Conclusions: Our study suggests that the Caprini RAM can be used to effectively stratify hospitalized Chinese patients into VTE risk categories based on individual risk factors. The classification of the highest risk level with a cumulative risk score of ≥ 5 provided significantly more clinical information, and further stratification of this group of patients is needed. J Atheroscler Thromb, 2014; 21:261-272.

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Section: Introductionmentioning

confidence: 99%

Validation of a Venous Thromboembolism Risk Assessment Model in Hospitalized Chinese Patients: A Case-Control Study

Zhou

Wang

et al. 2014

JAT

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“…Active quality improvement strategies in various hospitals in the UK based on similar interventions showed improvements in the rates of appropriate thromboprophylaxis from 59% to 70% (p < 0.05) and from 25% to 77% (p < 0.05) respectively. 14 This QIC has determined target standards that can be used for follow-up audits to monitor performance. This is important in maintaining a sustainable intervention that has been shown to be effective.…”

Section: Resultsmentioning

confidence: 99%

Preventing venous thromboembolism at a district hospital: a quality improvement study

Beutel

Jenkins

2015

South African Family Practice

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Background: Pulmonary embolism (PE) is the most common preventable cause of hospital deaths, and almost all hospitalised patients have at least one risk factor for venous thromboembolism (VTE). Despite the availability of highly effective thromboprophylaxis in preventing VTE, numerous studies worldwide have demonstrated its under-utilisation. The aim of this study was to review and improve the utilisation of thromboprophylaxis in the prevention of VTE in hospitalised patients at Oudtshoorn district hospital, and to make recommendations to the Western Cape Department of Health on how to improve the quality of care for patients at risk for VTE at district hospitals. Method: A quality improvement cycle (QIC). Retrospective analysis of files of adult patients admitted to the male and female wards at Oudtshoorn district hospital was performed prior to and after a five-month intervention phase. The target standards for the QIC were: (1) availability of a written hospital policy on VTE prevention; (2) every adult admission should have a formal VTE risk assessment documented; (3) every adult admission who is at risk for VTE should receive thromboprophylaxis. Results: Some 38% of adult patients admitted to Oudtshoorn Hospital, excluding the maternity ward, were at risk of developing VTE. There was no written hospital policy on VTE prevention. This was developed and made available during the intervention. In the pre-intervention group there were no patients who had a documented VTE risk assessment. The post intervention group showed a considerable increase with 45.2% having had a completed VTE risk assessment on admission (p < 0.001). In the pre-intervention group only 4.6% of patients who were at risk of VTE received thromboprophylaxis. There was a statistically significant difference in the number of patients at risk who received thromboprophylaxis in the post-intervention group where 36% of these patients received thromboprophylaxis (p < 0.001). Conclusions:The study identified a major shortcoming in the prevention of VTE in those patients at risk who were admitted to Oudtshoorn district hospital. An intervention as part of a quality improvement cycle has been able to demonstrate a significant improvement in the detection of patients who are at risk of VTE and a subsequent improvement in appropriate thromboprophylaxis. A number of barriers to their implementation have been identified and need to be addressed. This QIC may in time be of value to assist other district hospitals in addressing the issue of VTE prevention.

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“…1 Data from the American Heart Association (AHA)/American Stroke Association (ASA) Get With The Guidelines-Heart Failure (GWTG-HF) program continue to demonstrate a substantial gap between guideline recommendations and current care of patients with ADHF. 6,7 One way to promote systemwide adherence with published guidelines is to directly involve healthcare professionals in the implementation process.…”

Section: Evidence-based Guidelinesmentioning

confidence: 99%

“…Consequently, development of local, hospital-based procedures derived from national or international guidelines may be more effective than the simple dissemination of the guidelines themselves. 1 Hospitalists have a unique insight into both patient care and the hospital setting and are frequently involved in evaluating hospital policies and procedures and implementing clinical pathways and guidelines. 8 In addition, hospitalist care has been associated with greater compliance with disease-specific guidelines compared to nonhospitalist care.…”

Section: Evidence-based Guidelinesmentioning

confidence: 99%

“…Several quality improvement strategies have been identified, including provider education; provider reminder systems and decision support; audit and feedback; patient education; organizational change; and financial incentives, regulation, and policy. 1 To assist hospitalists in implementing these strategies, this article briefly reviews evidence-based guidelines for the treatment of ADHF, presents a practical algorithm for patient assessment and treatment derived from these guidelines and personal experience, and discusses systems to enhance the ultimate transition of patient care from the inpatient to outpatient setting.…”

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confidence: 99%

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Bridging the gap between evidence and practice in acute decompensated heart failure management

Michota

Amin

2008

J. Hosp. Med.

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Registry data indicate a gap between evidence-based guidelines and current management of patients with acute decompensated heart failure (ADHF). Bridging this gap is crucial given the frequency and cost of hospitalization for this disorder. Patients with ADHF require rapid assessment to determine appropriate treatment location and initial therapy. Patients with impending respiratory failure or cardiogenic shock should be managed in an intensive care setting, patients with congestion that is expected to require prolonged intravenous therapy should be admitted to the hospital, and patients with congestion that is likely to respond within 12-24 hours can be managed in an observation unit. Clinical status should guide selection of initial therapy. Initially, therapeutic response should be assessed every couple of hours. Once effective acute therapy has been established, it is important to implement strategies to improve long-term outcomes.These strategies include ensuring that care complies with established core performance measures, providing patient education in a manner suited to ensure comprehension and retention, and arranging for appropriate outpatient followup, ideally in a comprehensive heart failure disease management program. The purpose of this review is (1) to examine evidence-based guidelines for the treatment of ADHF, (2) to present a practical algorithm for patient assessment and treatment derived from these guidelines and personal experience, and (3) to discuss systems to enhance the ultimate transition of patient care from the inpatient to outpatient setting. Journal of Hospital Medicine 2008;3(Suppl 6):S7-S15.

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

Cited by 92 publications

References 35 publications

Validation of a Venous Thromboembolism Risk Assessment Model in Hospitalized Chinese Patients: A Case-Control Study

Validation of a Venous Thromboembolism Risk Assessment Model in Hospitalized Chinese Patients: A Case-Control Study

Preventing venous thromboembolism at a district hospital: a quality improvement study

Bridging the gap between evidence and practice in acute decompensated heart failure management

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