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Improving venous thromboembolism prophylaxis through critical thinking and health informatics
  1. Haytham Taha1,
  2. Ezhil Govindraj2,
  3. Filestin Jaber2,
  4. Ghadah Shehadeh3,
  5. Bernadette Kelly4,
  6. Siny Krishnan5,
  7. Wala Kamal Hamed6
  1. 1Medicine, Mafraq Hospital, Abu Dhabi, United Arab Emirates
  2. 2Quality, Mafraq Hospital, Abu Dhabi, United Arab Emirates
  3. 3Pharmacy, Mafraq Hospital, Abu Dhabi, United Arab Emirates
  4. 4Quality, SEHA, Abu Dhabi, United Arab Emirates
  5. 5Health Informatics, SEHA, Abu Dhabi, United Arab Emirates
  6. 6Internal Medicine, Mafraq Hospital, Abu Dhabi, United Arab Emirates
  1. Correspondence to Dr Haytham Taha; htaha{at}seha.ae

Abstract

Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality in hospitalised patients. Mafraq Hospital, a 450-bed tertiary-level hospital in Abu Dhabi, United Arab Emirates, has identified VTE prevention as a critical patient safety measure and VTE prophylaxis as a key performance indicator (KPI). Mafraq Hospital VTE prevention policy states that all admitted adult patients 18 years and above should receive a VTE risk assessment, and all patients identified at risk of VTE with no contraindications should receive appropriate VTE prophylaxis within 24 hours of admission. In a move towards safer practices, our governing body, Abu Dhabi Health Services SEHA, has raised the VTE prophylaxis KPI target from 85% to 95% for all admitted adult patients within 24 hours of admission. Our average VTE prophylaxis rate was 87%, and achieving this new target was a challenge. We conducted this study on Mafraq Hospital Medical and Surgical wards. The study period was 12 months, from July 2018 to June 2019, and a total of 5475 patients were evaluated. Our aim was to improve VTE prophylaxis rates in order to ensure patient safety and reduce preventable harm. We used Caprini Model electronic VTE risk assessment computerised decision support tool to help identify VTE risk. A multidisciplinary task force team was formed and led this quality improvement project. The purpose of this publication was to indicate the quality improvement interventions implemented to enhance compliance with VTE prophylaxis using integrated critical thinking and health informatics and the outcomes of those interventions. Through implementing critical thinking and health informatics interventions, our VTE prophylaxis within 24 hours of admission rates improved from an average 87% in July 2018 to above 98%, and this improvement was sustained over the last 3 months of the study period April through June 2019.

  • venous thromboembolism
  • healthcare quality improvement
  • patient safety
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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors HT participated in the brainstorming sessions and root cause analysis; provided education and training to physicians on proper VTE risk assessment tool documentation; planned the study, and prepared and submitted the study manuscript; was responsible for the overall content. EG participated in brainstorming sessions and root cause analysis, ran concurrent VTE prophylaxis report and shared the data with physicians in order to raise awareness, provided the VTE risk assessment and VTE prophylaxis run charts. FJ participated in brainstorming sessions and root cause analysis, ran concurrent VTE prophylaxis report and shared the data with physicians in order to raise awareness. GS participated in brainstorming sessions and root cause analysis, conducted a real-time audit with phone call physician reminders to place VTE prophylaxis order within 24 hours. BK participated in the brainstorming sessions and root cause analysis, changed the VTE prophylaxis trigger to physician-entered risk level instead of the previous tool-generated risk score. SK participated in the brainstorming sessions and root cause analysis, and linked the VTE risk assessment tool to the VTE prophylaxis order and updated the VTE risk assessment tool. WKH participated in brainstorming sessions and root cause analysis, provided education and training to physicians on proper VTE risk assessment tool documentation and participated in preparing the study manuscript.

  • Funding This study was funded by Mafraq hospital.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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