243721 Gaps in the practice of evidence-based prophylaxis reported among three patient groups at increased risk for deep vein thrombosis and pulmonary embolism demonstrate the need for expanded use of technologies that would promote physician education and patient safety in hospitals

Monday, October 31, 2011: 1:30 PM

Alan Brownstein, MPH , National Blood Clot Alliance, Tarrytown, NY
Gregory A. Maynard, MD, MSc , University of California, Chief, Division of Hospital Medicine, San Diego, CA
Richard J. Friedman, MD, FRCSC , Charleston Orthopaedic Associates, Charleston, SC
Elizabeth Varga, MS, CGC , Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH
Lisa Fullam , Lisa Fullam & Associates, Scottsdale, AZ
Jack Ansell, MD , Department of Medicine, Lenox Hill Hospital, New York, NY
Background. Deep vein thrombosis (DVT) and pulmonary embolism (PE) impose a major public health burden in the United States, affecting up to 600,000 individuals and accounting for ~100,000 deaths each year, according to The Surgeon General's Call to Action (CTA) To Prevent Deep Vein Thrombosis and Pulmonary Embolism. Improved awareness and clinical application of evidence-based interventions, such as the top-ranked patient safety strategy of DVT/PE prophylaxis, can prevent morbidity and mortality associated with DVT/PE, according to this CTA. DVT/PE is hospital acquired in 70% of all cases, and DVT/PE is the most common preventable cause of hospital death. A survey was conducted among three at-risk patient populations to measure the DVT/PE prophylaxis experiences reported by these groups. Methods: Patients enrolled in this survey, screened from online research panels, were representative of target at-risk patient groups, including: 500 patients hospitalized for >3 days, mean age 52.5 (64% female), 500 patients diagnosed with cancer, mean age 57.8 (64% female) (41% required hospitalization for treatment), and 250 patients who had undergone a partial and/or full hip/knee replacement (THA/TKA), mean age 53.6 (55% female). Criteria for patient group selection had to have been met within 12 months of survey fielding. Results: When surveyed about events that took place during their medical problem, all patient groups reported suboptimal prophylaxis experiences: The use of blood thinning pills was reported by 28% of patients hospitalized for >3 days, 21% of cancer patients, and 58% of THA/TKA patients. Similarly, the use of blood thinners injected under the skin was reported by 29% of patients hospitalized for >3 days, 16% of cancer patients, and 46% of THA/TKA patients. The use of compression hose and mechanical compression devices among the at-risk patients surveyed was: patients hospitalized for >3 days 39% compression hose, 37% compression devices, cancer patients 35% compression hose, 31% compression devices, and THA/TKA patients compression hose 74%, compression devices 57%. Aspirin use was reported by 42% of THA/TKA patients, 37% of patients hospitalized for >3 days, and 28% of oncology patients. Conclusion: The application of existing evidence-based guidelines for DVT/PE prophylaxis was suboptimal among all at-risk patient populations surveyed. Expanded use of technologies (e.g. electronic medical records integrated with patient order-sets, computerized reminders, and correction alerts) directed at improved physician education and increased adherence to optimal care could improve patient safety, substantially reducing DVT/PE morbidity and mortality.

Learning Areas:
Administer health education strategies, interventions and programs
Advocacy for health and health education
Clinical medicine applied in public health
Communication and informatics
Planning of health education strategies, interventions, and programs
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Identify gaps in the practice of evidence-based prophylaxis in relation to DVT/PE prophylaxis experiences reported by individuals in at-risk patient groups. 2. Demonstrate the potential to improve patient safety in hospitals through appropriate use of DVT/PE prophlylaxis to at-risk patient groups. 3. Describe how to reduce DVT/PE-related morbidity and mortality in hospitals through the use of technologies to promote physician education.

Keywords: Quality Improvement, Hospitals

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: N/A

Qualified on the content I am responsible for because: I am the Co-PI in developing the methodology and design of the survey instrument used to collect the data and responsible for data analyzes in consultation with an independent scientific steering committee.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Ortho-McNeil, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc DVT/PE Awareness Survey My employer received grant support
Bristol - Myers Squibb general education grants My employer received grant support
Eisai general education grants My employer received grant support
GlaxoSmithKline general education grants My employer received grant support
Talecris Biotherapeutics general education grants My employer received grant support
Lundbeck general education grants My employer received grant support

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.