Prevention of venous thromboembolism through the implementation of a risk assessment tool: a comparative study in medical and surgical patients

BACKGROUND: Hospitalized patients are at high risk of venous thromboembolism (VTE). Underutilization of thromboprophylaxis remains common despite existing clinical guidelines. The aim is to evaluate the implementation of a state wide standardized adult VTE risk assessment tool (RAT) to assist in the screening of inpatients and prescribing of appropriate thromboprophylaxis. METHODS: In total, 234 patients were audited using clinical notes and spot assessments for VTE risk at Western Sydney Local Health District over a two year period. Patients were stratified into pre- (N.=132) and postimplementation (N.=102) of the RAT. Intervention involved continuing education of staff and passive dissemination of guidelines. Prescription of pharmacological and mechanical prophylaxis and the development of thromboembolic events were evaluated. RESULTS: Overall, 39.0% of medical and 63.0% of surgical patients were risk assessed during preimplementation versus 39.2% and 92.2% during postimplementation of the RAT (P<0.0001). Usage of pharmacological prophylaxis increased from 72% to 79% and mechanical prophylaxis from 41% to 48%. VTE rates in moderate to high risk medical patients decreased from 15.2% preimplementation to 6.5% postimplementation. Rates of non-fatal and fatal pulmonary embolism (PE) were 2.3% and 0.8% respectively prior compared to 1.0% and 0.0% postimplementation. CONCLUSIONS: Standardized VTE RAT increased thromboprophylaxis usage and decreased PE rates, with a greater improvement reflected in surgical patients. These findings highlight the importance of a multifaceted approach to VTE prevention using regular audits with feedback, electronic reminders systems, prescribing tools and continuing education.