Venous thromboembolism prevention compliance: A multidisciplinary educational approach utilizing NSQIP best practice guidelines

Am J Surg. 2020 Nov;220(5):1333-1337. doi: 10.1016/j.amjsurg.2020.06.059. Epub 2020 Jul 8.

Abstract

Background: Review of our institutional National Surgical Quality Improvement Project (NSQIP) data found higher rate of Venous Thromboembolic Events (VTE) (2.5% vs. 1.1%). Compared to the national benchmark. Our goal was to identify opportunities for quality improvement.

Methods: We compared NSQIP general surgery data from January 2015-December 2016 (period 1) to January 2017-December 2018 (period 2). A multidisciplinary committee was developed and patient centered education implemented to enhance VTE compliance.

Results: Over 50% of all the patients who developed VTE were non-compliant with chemical prophylaxis. The majority of non-compliance was due to pain. During period 1 there were 12 VTEs in 482 cases, while in period two, 18 VTEs in 2347 cases (2.5% vs. 0.8%; RR 2.3, 95% CI 1.5-3.7, p < 0.001). Missed chemical prophylaxis decreased from 50 to 17 per week after the intervention.

Conclusion: A multidisciplinary, patient centered approach to increase VTE prevention decreases VTE rates to below a comparable benchmark.

Keywords: NSQIP; Quality improvement; VTE.

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / therapeutic use*
  • Benchmarking
  • Databases, Factual
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Patient Education as Topic / standards*
  • Postoperative Care / methods
  • Postoperative Care / standards*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control*
  • Practice Guidelines as Topic
  • Quality Improvement
  • Risk Factors
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*

Substances

  • Anticoagulants