Translating venous thromboembolism prevention guidelines into practice through system redesign

Background: Venous thromboembolism (VTE) is a major public health problem, which is a primary concern of hospitalized or recently hospitalized patients. Pulmonary embolism resulting from deep vein thrombosis (DVT) is the most common preventable cause of death occurring in the hospital. System redesign is suggested to improve in compliance with practice guidelines. This study assessed the impact of ward-based Knowledge Translation (KT) monitor on the implementations of evidence-based thromboprophylaxis guidelines and its compliance. Materials and Methods: The study was conducted at the Department of Medicine, in a tertiary-care hospital. In addition to staff education, a risk-scoring template and employment of a Knowledge Translation (KT) monitor were undertaken. The KT monitor was specifically trained to assess the risk of venous thromboembolism (VTE) for all medical in-patients. Patients on no, suboptimal or contraindicated prophylaxis interventions were identified by the monitor. The treating team is immediately contacted to initiate the recommended corrective measures. The monitor will subsequently follow these patients to guarantee the commencement of action for treatment. Results: After eliminating the non-eligible patients, 602 individuals were eligible for prophylactic anticoagulation. Four hundred and thirty (71%) of these patients were receiving appropriate VTE prophylaxis, 124 patients (21%) were receiving suboptimal doses of subcutaneous heparin and 48 eligible patients (8%) were not receiving any intervention for prophylaxis. All those 48 patients (not on prophylaxis) were subsequently commenced on the appropriate method and dose of VTE prophylaxis after contacting the primary physicians. Patients on suboptimal prophylaxis were referred to the teams and 82 of these patients thromboprophylaxis were adjusted to the optimal dose. Conclusion: Implementation of multifaceted interventions with system redesign and employment of a ward-based Knowledge Translation (KT) monitor resulted in significant improvements in appropriate VTE prophylaxis.