TY - JOUR
T1 - Prevention of perioperative venous thromboembolism and coronary events
T2 - Differential responsiveness to an intervention program to improve guidelines adherence
AU - Grupper, A.
AU - Rudin, D.
AU - Drenger, B.
AU - Varon, D.
AU - Gilon, D.
AU - Gielchinsky, Y.
AU - Menashe, M.
AU - Mintz, Y.
AU - Rivkind, A.
AU - Brezis, M.
PY - 2006/4
Y1 - 2006/4
N2 - Introduction. Prevention of venous thromboembolism and coronary events (with β-blockers) during and after surgery is at the top of a list of safety practices for hospitalized patients, recommended by the Agency for Health Care Research and Quality (AHRQ). We wished to determine and improve adherence to clinical guidelines for these topics in our institution. Patients, material, and methods. A prospective survey was conducted over several weeks on operated patients in a 1200-beds medical center (a teaching, community and referral hospital in Jerusalem, Israel). Eligibility for and actual administration of prophylactic treatment with anticoagulant and β-blockers were determined. Following an intervention program, which included staff meetings, development of local protocols, and academic detailing by a nurse, the survey was repeated. Results. In general, adherence to recommended anticoagulation prophylaxis was low, found in only 29% [95% confidence interval (CI) = 23-36] of eligible patients. After the intervention, adequate anticoagulation increased to 50% (95% CI = 40-59) of eligible patients (P < 0.001). Initiation of β-blockers in preventing perioperative cardiac events was very low (0%, 95% CI = 0-5%) and did not increase after intervention. Conclusions. Adherence to guidelines for prevention of surgical complications was found to be low in our institution. A multifaceted intervention significantly increased use of prophylaxis for venous thromboembolism but not for coronary events. This differential response suggests that the success of a quality improvement project strongly depends on topic content and its phase of acceptance.
AB - Introduction. Prevention of venous thromboembolism and coronary events (with β-blockers) during and after surgery is at the top of a list of safety practices for hospitalized patients, recommended by the Agency for Health Care Research and Quality (AHRQ). We wished to determine and improve adherence to clinical guidelines for these topics in our institution. Patients, material, and methods. A prospective survey was conducted over several weeks on operated patients in a 1200-beds medical center (a teaching, community and referral hospital in Jerusalem, Israel). Eligibility for and actual administration of prophylactic treatment with anticoagulant and β-blockers were determined. Following an intervention program, which included staff meetings, development of local protocols, and academic detailing by a nurse, the survey was repeated. Results. In general, adherence to recommended anticoagulation prophylaxis was low, found in only 29% [95% confidence interval (CI) = 23-36] of eligible patients. After the intervention, adequate anticoagulation increased to 50% (95% CI = 40-59) of eligible patients (P < 0.001). Initiation of β-blockers in preventing perioperative cardiac events was very low (0%, 95% CI = 0-5%) and did not increase after intervention. Conclusions. Adherence to guidelines for prevention of surgical complications was found to be low in our institution. A multifaceted intervention significantly increased use of prophylaxis for venous thromboembolism but not for coronary events. This differential response suggests that the success of a quality improvement project strongly depends on topic content and its phase of acceptance.
KW - Academic detailing
KW - Barriers to quality improvement
KW - Beta blockers
KW - Diffusion of innovations
KW - Guidelines adherance
KW - Thromboembolism prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=33645542720&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzi083
DO - 10.1093/intqhc/mzi083
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C2 - 16234299
AN - SCOPUS:33645542720
SN - 1353-4505
VL - 18
SP - 123
EP - 126
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 2
ER -