Background:
Complications from venous thromboembolism (VTE) kill more Americans each year than AIDS and breast cancer combined. Despite evidence‐based knowledge regarding the benefits of venous thromboembolism (VTE) prophylaxis in hospitalized medical patients, as well as recommendations from national quality organizations, risk factor screening has not been routinely applied. We aimed to determine if an abbreviated screening tool increases the consistent use of appropriate prophylaxis methods for moderate‐ to high‐risk adult medical patients.
Methods:
We randomly attached 1 of 2 VTE screening tools to the preexisting admission order set utilized by our hospitalist service in 3 general medicine units. The first tool (analytical) utilized assignment of points to quantify individual patient risk factors, similar to the widely used Caprini scoring system. Based on the sum of the points, patients were assigned to low‐, moderate‐, and high‐VTE‐risk groups. The ordering physician was then given options for prophylaxis based on the patient's risk group. The second screening tool (presumptive) was modeled on research that has shown that more than 65% of adult medical patients admitted to the hospital fall into the moderate and high VTE risk categories. Therefore, the tool assumed that all patients need prophylaxis, except for those with low VTE risk or contraindications.
Results:
A total of 589 adult hospitalized ICU patients were included, generating 603 patient encounters. Of these encounters, 521 met study inclusion criteria, with 51% utilizing the analytical tool and 49% utilizing the presumptive tool. Of all included encounters, 69% demonstrated completed screening, and use of a screening tool was associated with a higher likelihood that moderate‐ and high‐risk patients received appropriate prophylaxis (P < 0.001). The screening rate was higher (89%) with the presumptive tool compared with the analytical tool (49%). This finding was statistically significant (P < 0.001). Use of the presumptive screening tool did result in a higher rate of prophylaxis in the low‐risk group.
Conclusions:
When screening was completed, moderate‐ and high‐risk patients were identified appropriately, and methods of prophylaxis applied accurately, regardless of which tool was used. However, use of the presumptive VTE screening tool resulted in a significantly higher completed screening rate than with use of the analytical tool. The significance of an increased use of prophylaxis in low‐risk patients is unknown at this time. Based on the results of this study, we recommend the use of a presumptive tool to increase reliability of screening and appropriate prophylaxis for moderate‐ and high‐risk medical patients.
Author Disclosure:
J. Adair, sanofi‐aventis, Speakers Bureau; M. Dallas, none; R. Hroncich, sanofi‐aventis; Pfizer, Speakers Bureau.