Hospital‐acquired venous thromboembolism (HA‐VTE) is a predictable complication that increases morbidity and mortality. Despite overwhelming evidence supporting the effectiveness of VTE prophylaxis, safe, effective, and cost‐efficient methods to prevent VTE remain underutilized. In the high‐risk patient population of a surgical intensive care unit (ICU), we examined the effect on HA‐VTE when a unit‐based multidisciplinary team conducted bedside rounds using a dynamic dashboard designed to enable real‐time visualization of VTE prophylaxis status.
A retrospective, observational analysis was conducted of all patients cared for in a single 20‐bed SICU for the 12 months before and after introduction of the dynamic dashboard (2008 vs. 2009). A total of 154 patients met inclusion criteria, having both a SICU stay and a diagnosis code for VTE. A total of 101 patients met exclusion criteria: 53 patients had VTE diagnosed prior to admission or within 48 hours of admission, and 48 patients had no radio‐graphic evidence to confirm the diagnosis of VTE despite the diagnosis code for VTE. The primary outcome was the rate of HA‐VTE per 1000 patient‐days. Secondary outcomes were the rates of lower‐extremity deep vein thrombosis (DVT), upper‐extremity DVT, pulmonary embolism, and potentially preventable HA‐VTE per 1000 patient‐days, which was defined as development of a HA‐VTE in the absence of VTE prophylaxis.
In 2008, 35 patients developed an HA‐VTE, compared with 18 in 2009. The rate of HA‐VTE per 1000 patient‐days decreased from 5.84 to 3.10 (RR, 1.89; CI, 1.04–3.53; P = 0.036). The rate of potentially preventable HA‐VTE per 1000 patient‐days decreased from 2.00 to 0.52 (RR, 3.87; CI, 1.05–21.39; P = 0.041). Other secondary outcomes were reduced but did not achieve statistical significance.
The addition of real‐time visualization of VTE prophylaxis status to multidisciplinary bedside rounds coincided with decreased rates of HA‐VTE in a SICU. Combining real‐time, actionable performance data with the structure and accountability afforded by daily unit‐based multidisciplinary rounding teams may represent an important mechanism to improve hospital outcomes.
J. Stein ‐ Emory, entitled to royalty payments from Emory patent licensed commercially; M. Chesson ‐ none; A. Killian ‐ none; J. Rykowski ‐ none; T. Leong ‐ none; D. Tong ‐ none