Adherence to thromboprophylaxis guidelines in elderly patients with hospital acquired venous thromboembolism: a case control study
Venous thromboembolism ( VTE) remains the number one preventable cause of hospital acquired mortality and morbidity. Each year, more than 12 million patients are at risk for VTE. The delivery of appropriate and timely VTE prophylaxis is still suboptimal in many healthcare institutions and can lead t...
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| Veröffentlicht in: | Journal of thrombosis and thrombolysis 2017-02, Vol.43 (2), p.172-178 |
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| creator | Suh, Jason Desai, Amishi Desai, Anish Cruz, Josephine Dela Mariampillai, Anusiyanthan Hindenburg, Alexander |
| description | Venous thromboembolism
(
VTE) remains the number one preventable cause of hospital acquired mortality and morbidity. Each year, more than 12 million patients are at risk for VTE. The delivery of appropriate and timely VTE prophylaxis is still suboptimal in many healthcare institutions and can lead to increased readmissions, morbidity, as well as costs. To clarify this issue further, we performed a retrospective case control study at our institution to determine if poor adherence to the VTE prophylaxis guidelines could lead to an increase in VTE events. This was a retrospective case control study conducted at Winthrop-University Hospital from January 2007 to December 2011. Exclusion criteria were age |
| doi_str_mv | 10.1007/s11239-016-1432-6 |
| format | Article |
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(
VTE) remains the number one preventable cause of hospital acquired mortality and morbidity. Each year, more than 12 million patients are at risk for VTE. The delivery of appropriate and timely VTE prophylaxis is still suboptimal in many healthcare institutions and can lead to increased readmissions, morbidity, as well as costs. To clarify this issue further, we performed a retrospective case control study at our institution to determine if poor adherence to the VTE prophylaxis guidelines could lead to an increase in VTE events. This was a retrospective case control study conducted at Winthrop-University Hospital from January 2007 to December 2011. Exclusion criteria were age < 18 and concurrent use of anticoagulant agents. Out of 322 cases of hospital acquired VTE or readmission with VTE within 30 days of discharge, 289 cases were selected for final analysis and paired with age and sex matched controls. Patients with a hospital acquired VTE or a readmission for VTE within 30 days of discharge had a significantly reduced rate of VTE prophylaxis when compared to the control group (54.0 vs. 79.2 %, p < 0.0001). The VTE risk assessment rate was also lower in the VTE group (77.2 vs. 85.5 %, p = 0.035). No difference was noted in the time to prophylaxis administration between the two groups (34.8 vs. 33.1 h, p = 0.34). Lastly, sequential compression device (SCD) documentation rate was not different: 68/116 (58.6 %) vs. 44/87 (50.6 %), p = 0.32, between the two arms. Low adherence to the American College of Chest Physician (ACCP) guidelines for VTE prophylaxis correlated with an increase in hospital acquired VTE. The decreased adherence may be linked to a lower VTE risk assessment rate, and other barriers including incorrect identification of contraindications to pharmacologic prophylaxis, and poor documentation of mechanical prophylaxis. There was no difference in SCD documentation rate and timeliness to administration of initial thromboprophylaxis between the two groups. Future studies are needed to reassess adherence and documentation rates after system-wide improvements.</description><identifier>ISSN: 0929-5305</identifier><identifier>EISSN: 1573-742X</identifier><identifier>DOI: 10.1007/s11239-016-1432-6</identifier><identifier>PMID: 27752864</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cardiology ; Case-Control Studies ; Contraindications ; Female ; Guideline Adherence - standards ; Hematology ; Humans ; Iatrogenic Disease ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Premedication - methods ; Recurrence ; Retrospective Studies ; Risk Assessment ; Venous Thromboembolism - etiology ; Venous Thromboembolism - prevention & control</subject><ispartof>Journal of thrombosis and thrombolysis, 2017-02, Vol.43 (2), p.172-178</ispartof><rights>Springer Science+Business Media New York 2016</rights><rights>Journal of Thrombosis and Thrombolysis is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-6c9ac02b12e9fedadde197ca61108649eda4bc294e416b75af86ffd99690d09c3</citedby><cites>FETCH-LOGICAL-c372t-6c9ac02b12e9fedadde197ca61108649eda4bc294e416b75af86ffd99690d09c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11239-016-1432-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11239-016-1432-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27752864$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Suh, Jason</creatorcontrib><creatorcontrib>Desai, Amishi</creatorcontrib><creatorcontrib>Desai, Anish</creatorcontrib><creatorcontrib>Cruz, Josephine Dela</creatorcontrib><creatorcontrib>Mariampillai, Anusiyanthan</creatorcontrib><creatorcontrib>Hindenburg, Alexander</creatorcontrib><title>Adherence to thromboprophylaxis guidelines in elderly patients with hospital acquired venous thromboembolism: a case control study</title><title>Journal of thrombosis and thrombolysis</title><addtitle>J Thromb Thrombolysis</addtitle><addtitle>J Thromb Thrombolysis</addtitle><description>Venous thromboembolism
(
VTE) remains the number one preventable cause of hospital acquired mortality and morbidity. Each year, more than 12 million patients are at risk for VTE. The delivery of appropriate and timely VTE prophylaxis is still suboptimal in many healthcare institutions and can lead to increased readmissions, morbidity, as well as costs. To clarify this issue further, we performed a retrospective case control study at our institution to determine if poor adherence to the VTE prophylaxis guidelines could lead to an increase in VTE events. This was a retrospective case control study conducted at Winthrop-University Hospital from January 2007 to December 2011. Exclusion criteria were age < 18 and concurrent use of anticoagulant agents. Out of 322 cases of hospital acquired VTE or readmission with VTE within 30 days of discharge, 289 cases were selected for final analysis and paired with age and sex matched controls. Patients with a hospital acquired VTE or a readmission for VTE within 30 days of discharge had a significantly reduced rate of VTE prophylaxis when compared to the control group (54.0 vs. 79.2 %, p < 0.0001). The VTE risk assessment rate was also lower in the VTE group (77.2 vs. 85.5 %, p = 0.035). No difference was noted in the time to prophylaxis administration between the two groups (34.8 vs. 33.1 h, p = 0.34). Lastly, sequential compression device (SCD) documentation rate was not different: 68/116 (58.6 %) vs. 44/87 (50.6 %), p = 0.32, between the two arms. Low adherence to the American College of Chest Physician (ACCP) guidelines for VTE prophylaxis correlated with an increase in hospital acquired VTE. The decreased adherence may be linked to a lower VTE risk assessment rate, and other barriers including incorrect identification of contraindications to pharmacologic prophylaxis, and poor documentation of mechanical prophylaxis. There was no difference in SCD documentation rate and timeliness to administration of initial thromboprophylaxis between the two groups. Future studies are needed to reassess adherence and documentation rates after system-wide improvements.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiology</subject><subject>Case-Control Studies</subject><subject>Contraindications</subject><subject>Female</subject><subject>Guideline Adherence - standards</subject><subject>Hematology</subject><subject>Humans</subject><subject>Iatrogenic Disease</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Premedication - methods</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Venous Thromboembolism - etiology</subject><subject>Venous Thromboembolism - prevention & control</subject><issn>0929-5305</issn><issn>1573-742X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU1rFTEUhoMo9lr9AW4k4Kab0XzMJDfuSrEqFNwouAuZ5EwnJZNMk4x6t_5yU24rIrgIgeQ57zmHB6GXlLyhhMi3hVLGVUeo6GjPWSceoR0dJO9kz749RjuimOoGToYT9KyUG0KIUoQ9RSdMyoHtRb9Dv87dDBmiBVwTrnNOy5jWnNb5EMxPX_D15h0EH6FgHzEEBzkc8Gqqh1gL_uHrjOdUVl9NwMbebj6Dw98hpq085EE7wZflHTbYmgLYplhzCrjUzR2eoyeTCQVe3N-n6Ovl-y8XH7urzx8-XZxfdZZLVjthlbGEjZSBmsAZ54AqaY2glLRVVHvqR8tUDz0VoxzMtBfT5JQSijiiLD9FZ8fctt7tBqXqxRcLIZgIbVhN93zoBy572tDX_6A3acuxTdcoSahSjPJG0SNlcyolw6TX7BeTD5oSfSdIHwXpJkjfCdKi1by6T97GBdyfigcjDWBHoLSveA35r9b_Tf0NYz-e7A</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Suh, Jason</creator><creator>Desai, Amishi</creator><creator>Desai, Anish</creator><creator>Cruz, Josephine Dela</creator><creator>Mariampillai, Anusiyanthan</creator><creator>Hindenburg, Alexander</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20170201</creationdate><title>Adherence to thromboprophylaxis guidelines in elderly patients with hospital acquired venous thromboembolism: a case control study</title><author>Suh, Jason ; Desai, Amishi ; Desai, Anish ; Cruz, Josephine Dela ; Mariampillai, Anusiyanthan ; Hindenburg, Alexander</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-6c9ac02b12e9fedadde197ca61108649eda4bc294e416b75af86ffd99690d09c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiology</topic><topic>Case-Control Studies</topic><topic>Contraindications</topic><topic>Female</topic><topic>Guideline Adherence - standards</topic><topic>Hematology</topic><topic>Humans</topic><topic>Iatrogenic Disease</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Premedication - methods</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Venous Thromboembolism - etiology</topic><topic>Venous Thromboembolism - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Suh, Jason</creatorcontrib><creatorcontrib>Desai, Amishi</creatorcontrib><creatorcontrib>Desai, Anish</creatorcontrib><creatorcontrib>Cruz, Josephine Dela</creatorcontrib><creatorcontrib>Mariampillai, Anusiyanthan</creatorcontrib><creatorcontrib>Hindenburg, Alexander</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of thrombosis and thrombolysis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suh, Jason</au><au>Desai, Amishi</au><au>Desai, Anish</au><au>Cruz, Josephine Dela</au><au>Mariampillai, Anusiyanthan</au><au>Hindenburg, Alexander</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adherence to thromboprophylaxis guidelines in elderly patients with hospital acquired venous thromboembolism: a case control study</atitle><jtitle>Journal of thrombosis and thrombolysis</jtitle><stitle>J Thromb Thrombolysis</stitle><addtitle>J Thromb Thrombolysis</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>43</volume><issue>2</issue><spage>172</spage><epage>178</epage><pages>172-178</pages><issn>0929-5305</issn><eissn>1573-742X</eissn><abstract>Venous thromboembolism
(
VTE) remains the number one preventable cause of hospital acquired mortality and morbidity. Each year, more than 12 million patients are at risk for VTE. The delivery of appropriate and timely VTE prophylaxis is still suboptimal in many healthcare institutions and can lead to increased readmissions, morbidity, as well as costs. To clarify this issue further, we performed a retrospective case control study at our institution to determine if poor adherence to the VTE prophylaxis guidelines could lead to an increase in VTE events. This was a retrospective case control study conducted at Winthrop-University Hospital from January 2007 to December 2011. Exclusion criteria were age < 18 and concurrent use of anticoagulant agents. Out of 322 cases of hospital acquired VTE or readmission with VTE within 30 days of discharge, 289 cases were selected for final analysis and paired with age and sex matched controls. Patients with a hospital acquired VTE or a readmission for VTE within 30 days of discharge had a significantly reduced rate of VTE prophylaxis when compared to the control group (54.0 vs. 79.2 %, p < 0.0001). The VTE risk assessment rate was also lower in the VTE group (77.2 vs. 85.5 %, p = 0.035). No difference was noted in the time to prophylaxis administration between the two groups (34.8 vs. 33.1 h, p = 0.34). Lastly, sequential compression device (SCD) documentation rate was not different: 68/116 (58.6 %) vs. 44/87 (50.6 %), p = 0.32, between the two arms. Low adherence to the American College of Chest Physician (ACCP) guidelines for VTE prophylaxis correlated with an increase in hospital acquired VTE. The decreased adherence may be linked to a lower VTE risk assessment rate, and other barriers including incorrect identification of contraindications to pharmacologic prophylaxis, and poor documentation of mechanical prophylaxis. There was no difference in SCD documentation rate and timeliness to administration of initial thromboprophylaxis between the two groups. Future studies are needed to reassess adherence and documentation rates after system-wide improvements.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27752864</pmid><doi>10.1007/s11239-016-1432-6</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Cardiology Case-Control Studies Contraindications Female Guideline Adherence - standards Hematology Humans Iatrogenic Disease Male Medicine Medicine & Public Health Middle Aged Premedication - methods Recurrence Retrospective Studies Risk Assessment Venous Thromboembolism - etiology Venous Thromboembolism - prevention & control |
| title | Adherence to thromboprophylaxis guidelines in elderly patients with hospital acquired venous thromboembolism: a case control study |
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