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Practices to prevent venous thromboembolism: a brief review
  1. Brandyn D Lau1,2,
  2. Elliott R Haut1,3,4,5,6
  1. 1Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Division of General Internal Medicine, Department of Medicine, Evidence-based Practice Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  5. 5The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
  6. 6The Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr E R Haut, Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Sheikh Zayed 6107C, Baltimore, MD 21287, USA; ehaut1{at}jhmi.edu

Abstract

Background Venous thromboembolism (VTE) is a common cause of preventable harm for hospitalised patients. Over the past decade, numerous intervention types have been implemented in attempts to improve the prescription of VTE prophylaxis in hospitals, with varying degrees of success. We reviewed key articles to assess the efficacy of different types of interventions to improve prescription of VTE prophylaxis for hospitalised patients.

Methods We conducted a search of MEDLINE for key studies published between 2001 and 2012 of interventions employing education, paper based tools, computerised tools, real time audit and feedback, or combinations of intervention types to improve prescription of VTE prophylaxis for patients in hospital settings. Process outcomes of interest were prescription of any VTE prophylaxis and best practice VTE prophylaxis. Clinical outcomes of interest were any VTE and potentially preventable VTE, defined as VTE occurring in patients not prescribed appropriate prophylaxis.

Results 16 articles were included in this review. Two studies employed education only, four implemented paper based tools, four used computerised tools, two evaluated audit and feedback strategies, and four studies used combinations of intervention types. Individual modalities result in improved prescription of VTE prophylaxis; however, the greatest and most sustained improvements were those that combined education with computerised tools.

Conclusions Many intervention types have proven effective to different degrees in improving VTE prevention. Provider education is likely a required additional component and should be combined with other intervention types. Active mandatory tools are likely more effective than passive ones. Information technology tools that are well integrated into provider workflow, such as alerts and computerised clinical decision support, can improve best practice prophylaxis use and prevent patient harm resulting from VTE.

  • Quality improvement methodologies
  • Quality improvement
  • Decision support, clinical

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