Real-Time Performance Data Improved VTE Prophylaxis

CHICAGO — Real-time relay of the venous thromboembolism prophylaxis order status of all patients at a 550-bed tertiary care teaching hospital increased prophylaxis usage in the ICU and in medical and surgical units.

For at least 5 months after the intervention, 15 nursing units averaged a greater than 90% prevalence of venous thromboembolism (VTE) prophylaxis, a level reached by just 5 units prior to the intervention, Dr. Jason Stein and his colleagues at Emory University, Atlanta, reported in a poster at the annual meeting of the Society of Hospital Medicine.

Pulmonary embolism resulting from VTE is the leading preventable cause of hospital death. Yet a large U.S. registry study showed that most hospitalized patients with risk factors for deep-vein thrombosis did not receive prophylaxis (Am. J. Cardiol. 2004;93:259–62).

In the current study, pharmacologic VTE prophylaxis in the surgical ICU significantly increased from 78% at baseline to 94% after the intervention. That occurred without a significant rise in lone mechanical prophylaxis, which increased from 17.3% to 19.6%.

In a medical nursing unit, the intervention led to a significant increase in overall VTE prophylaxis (from 85% to 91%) that was almost entirely attributable to an increase in lone mechanical prophylaxis (from 14.6% to 20.2%).

Frontline processes, such as rounding format or timing of capture of new orders, may modulate the effect of the program, and thus explain the different outcomes between the two units, Dr. Stein and his colleagues said.

In the surgical ICU, simultaneous physical rounding on every patient is conducted every morning by all members of the frontline clinical team, including the responsible physician. A clinical pharmacist views the real-time relay-and-display program prior to rounds to call attention to appropriateness of VTE prophylaxis during rounds. New VTE prophylaxis orders are discussed and captured via new physician orders during rounds.

In contrast, the rounding format in the medical unit is asynchronous physical rounding on patients by clinical team members. A multidisciplinary team meets on weekday mornings to discuss patients. The charge nurse views the relay-and-display program to call attention to patients, with no order for VTE prophylaxis during the team meeting. New orders are discussed but not captured during the meeting, and the nurse follows up ad hoc.

“More research is needed to examine sustainability and to clarify features of the most effective implementations of relay-and-display strategies in hospitals,” they said.

Dr. Stein disclosed stock holdings with Ingenious Med Inc. as well as honoraria from Sanofi.