This study was not blinded. Medical wards in the control group received “usual care”, which we defined as having no active or passive KT strategies to improve thromboprophylaxis in place. Medical wards in the intervention group received a multicomponent intervention consisting of the following:
1. Education sessions: Distribution of posters; a pamphlet describing current VTE practice patterns and the need to optimize thromboprophylaxis; and bimonthly educational sessions for ward physicians (and house staff, if applicable), nurses, and pharmacists. Pamphlets were distributed in paper format and via electronic mail to individuals who could not attend the sessions.
2. Standardized VTE risk assessment algorithm and physicians’ orders: (see Figure1 ) These paper-based forms, modeled after the 8th edition of the ACCP Evidence-Based Clinical Practice Guidelines, were available on internal medicine wards during the study period [4 (link)]. Local principal investigators (PIs) were asked to ensure that clinical staff were aware of the forms and to encourage their completion for eligible patients.
3. Audit and feedback: Real-time chart audits of eligible patients were done to determine whether patients were appropriately managed for thromboprophylaxis within 24 hours of admission. The entire health record during the relevant admission was searched to corroborate thrombosis and bleeding risk factors. All audits were done by one of two data management assistants, and data entry was validated by the study coordinator (NL) and two research assistants. Performance-based feedback sessions were done at 4, 12, and 16 weeks to relay results to clinical staff. Aggregate feedback was provided verbally and in a written handout at the sessions. The handout was also distributed in paper format and via electronic mail to individuals who could not attend the sessions.
1. Education sessions: Distribution of posters; a pamphlet describing current VTE practice patterns and the need to optimize thromboprophylaxis; and bimonthly educational sessions for ward physicians (and house staff, if applicable), nurses, and pharmacists. Pamphlets were distributed in paper format and via electronic mail to individuals who could not attend the sessions.
2. Standardized VTE risk assessment algorithm and physicians’ orders: (see Figure
3. Audit and feedback: Real-time chart audits of eligible patients were done to determine whether patients were appropriately managed for thromboprophylaxis within 24 hours of admission. The entire health record during the relevant admission was searched to corroborate thrombosis and bleeding risk factors. All audits were done by one of two data management assistants, and data entry was validated by the study coordinator (NL) and two research assistants. Performance-based feedback sessions were done at 4, 12, and 16 weeks to relay results to clinical staff. Aggregate feedback was provided verbally and in a written handout at the sessions. The handout was also distributed in paper format and via electronic mail to individuals who could not attend the sessions.
Free full text: Click here
