Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial

Implementation Science

James D Douketis¹  Holger J Schünemann¹  R Brian Haynes¹  Deborah J Cook¹  Frederick A Spencer²  Lehana Thabane³  Ji Cheng⁵  Nancy S Lloyd²  Menaka Pai⁴ 

[1] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada;Department of Medicine, McMaster University, Hamilton, ON, Canada;Centre for Evaluation of Medicines, St Joseph’s Healthcare—Hamilton, Hamilton, ON, Canada;Hamilton Regional Laboratory Medicine Program, Hamilton, ON, Canada;Biostatistics Unit, St Joseph’s Healthcare—Hamilton, Hamilton, ON, Canada

关键词: Standard orders;    Cluster randomization;    Venous thromboembolism;    Anticoagulants;    Medical patients;    Thromboprophylaxis;   

Others  :  813842
DOI  :  10.1186/1748-5908-8-1

 received in 2012-01-10, accepted in 2012-12-14,  发布年份 2013

【 摘 要 】

Background

Venous thromboembolism (VTE) is a common preventable cause of mortality in hospitalized medical patients. Despite rigorous randomized trials generating strong recommendations for anticoagulant use to prevent VTE, nearly 40% of medical patients receive inappropriate thromboprophylaxis. Knowledge-translation strategies are needed to bridge this gap.

Methods

We conducted a 16-week pilot cluster randomized controlled trial (RCT) to determine the proportion of medical patients that were appropriately managed for thromboprophylaxis (according to the American College of Chest Physician guidelines) within 24 hours of admission, through the use of a multicomponent knowledge-translation intervention. Our primary goal was to determine the feasibility of conducting this study on a larger scale. The intervention comprised clinician education, a paper-based VTE risk assessment algorithm, printed physicians’ orders, and audit and feedback sessions. Medical wards at six hospitals (representing clusters) in Ontario, Canada were included; three were randomized to the multicomponent intervention and three to usual care (i.e., no active strategies for thromboprophylaxis in place). Blinding was not used.

Results

A total of 2,611 patients (1,154 in the intervention and 1,457 in the control group) were eligible and included in the analysis. This multicomponent intervention did not lead to a significant difference in appropriate VTE prophylaxis rates between intervention and control hospitals (appropriate management rate odds ratio = 0.80; 95% confidence interval: 0.50, 1.28; p = 0.36; intra-class correlation coefficient: 0.022), and thus was not considered feasible. Major barriers to effective knowledge translation were poor attendance by clinical staff at education and feedback sessions, difficulty locating preprinted orders, and lack of involvement by clinical and administrative leaders. We identified several factors that may increase uptake of a VTE prophylaxis strategy, including local champions, support from clinical and administrative leaders, mandatory use, and a simple, clinically relevant risk assessment tool.

Conclusions

Hospitals allocated to our multicomponent intervention did not have a higher rate of medical inpatients appropriately managed for thromboprophylaxis than did hospitals that were not allocated to this strategy.

【 授权许可】

   
2013 Pai et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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