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Yu A, Birkemeier KL, Mills JR, Kuo T, Tachikawa N, Dai F, Thakkar K, Cable C, Brenner A, Godley PJ. Implementing a Quality Intervention to Improve Confidence in Outpatient Venous Thromboembolism Management. Cardiol Ther 2024:10.1007/s40119-024-00370-9. [PMID: 38773006 DOI: 10.1007/s40119-024-00370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/24/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Guidelines recommend that patients with acute venous thromboembolism (VTE) represented by low-risk deep vein thrombosis (DVT) and pulmonary embolism (PE) receive initial treatment at home versus at the hospital, but a large percentage of these patients are not managed at home. This study assessed the effectiveness of a quality intervention on provider knowledge and confidence in evaluating outpatient treatment for patients with VTE in the emergency department (ED). METHODS A pilot program to overcome obstacles to outpatient VTE treatment in appropriate patients was initiated at Baylor Scott & White Health Temple ED. Subsequently, a formalized quality intervention with a targeted educational program was developed and delivered to ED providers. Provider surveys were administered pre- and post-quality intervention in order to assess clinical knowledge, confidence levels, and perceived barriers. Patient discharge information was extracted from electronic health records. RESULTS Twenty-five ED providers completed the pre- and post-surveys; 690 and 356 patients with VTE were included in the pre- and post-pilot and pre- and post-quality intervention periods, respectively. Many ED providers reported that a major barrier to discharging patients to outpatient care was the lack of available and adequate patient follow-up appointments. Notably, after the quality intervention, an increase in provider clinical knowledge and confidence scores was observed. Discharge rates for patients with VTE increased from 25.6% to 27.5% after the pilot intervention and increased from 28.5% to 29.9% after the quality intervention, but these differences were not statistically significant. Despite instantaneous uptick in discharge rates after the interventions, there was not a long-lasting effect. CONCLUSION Although the quality intervention led to improvements in provider clinical knowledge and confidence and identified barriers to discharging patients with VTE, discharge rates remained stable, underscoring the need for additional endeavors.
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Affiliation(s)
- Anthony Yu
- Baylor Scott & White Health, 2401 S 31st St, Temple, TX, 76508, USA
| | | | - J Rebecca Mills
- Pfizer Inc, 66 Hudson Boulevard East, New York, NY, 10001-2192, USA
| | - Tiffany Kuo
- Baylor Scott & White Health, 2401 S 31st St, Temple, TX, 76508, USA
| | - Nina Tachikawa
- Pfizer Inc, 66 Hudson Boulevard East, New York, NY, 10001-2192, USA
| | - Feng Dai
- Pfizer Inc, 66 Hudson Boulevard East, New York, NY, 10001-2192, USA
| | - Karishma Thakkar
- Baylor Scott & White Health, 2401 S 31st St, Temple, TX, 76508, USA
| | - Christian Cable
- Baylor Scott & White Health, 2401 S 31st St, Temple, TX, 76508, USA
| | - Allison Brenner
- Pfizer Inc, 66 Hudson Boulevard East, New York, NY, 10001-2192, USA
| | - Paul J Godley
- Baylor Scott & White Health, 2401 S 31st St, Temple, TX, 76508, USA.
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Deep Vein Thrombosis Prophylaxis in Hospitalized Medical Patients: Current Recommendations, General Rates of Implementation, and Initiatives for Improvement. Clin Chest Med 2010; 31:675-89. [DOI: 10.1016/j.ccm.2010.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kent BD, Nadarajan P, Akasheh NB, Sulaiman I, Karim S, Cooney S, Lane SJ, Moloney ED. Improving venous thromboembolic disease prophylaxis in medical inpatients: a role for education and audit. Ir J Med Sci 2010; 180:163-6. [DOI: 10.1007/s11845-010-0619-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 10/04/2010] [Indexed: 12/17/2022]
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Maynard G, Stein J. Designing and implementing effective venous thromboembolism prevention protocols: lessons from collaborative efforts. J Thromb Thrombolysis 2010; 29:159-66. [PMID: 19902150 PMCID: PMC2813533 DOI: 10.1007/s11239-009-0405-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hospital acquired venous thromboembolism (VTE) is a major source of morbidity and mortality, yet proven prevention measures are often underutilized. The lack of a validated VTE risk assessment model, difficulty integrating VTE risk assessment and prevention protocols into the routine process of care, and the lack of standardized metrics for VTE prophylaxis have all been barriers. Recently, a VTE risk assessment/prevention protocol has been validated, leading to portable strategies achieving breakthrough levels of adequate prophylaxis in a variety of inpatient settings. VTE prevention protocol design and implementation strategies have been collected in implementation guides available from the Society of Hospital Medicine and the Agency for Healthcare Research and Quality. These guides were the centerpieces of national collaborative efforts to improve VTE involving over 150 medical centers, honing the approach to accelerate improvement described in this article. Embedding a VTE prevention protocol into admission, transfer, and perioperative order sets is a key strategy. A VTE prevention protocol is defined as a VTE risk assessment with no more than three levels of risk, tightly linked to recommended prophylaxis for each level. A balance between the need to provide protocol guidance and the need for efficiency and ease-of-use by the clinician must be maintained. The power of this protocol driven approach is bolstered by a quality improvement framework, multidisciplinary teams, ongoing monitoring of the process, and real time identification and mitigation of non-adherents via a technique that measures progress and prompts concurrent intervention, an approach we call “measure-vention.”
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Affiliation(s)
- Greg Maynard
- Division of Hospital Medicine, Department of Medicine, University of California, San Diego, San Diego, CA 92103-8485, USA.
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Passman MA. Mandated quality measures and economic implications of venous thromboembolism prevention and management. Am J Surg 2010; 199:S21-31. [DOI: 10.1016/j.amjsurg.2009.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 10/22/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
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Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of Venous Thromboembolism. Chest 2008; 133:381S-453S. [PMID: 18574271 DOI: 10.1378/chest.08-0656] [Citation(s) in RCA: 2862] [Impact Index Per Article: 178.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- William H Geerts
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Graham F Pineo
- Foothills Hospital, University of Calgary, Calgary, AB, Canada
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