OBJECTIVE: National guidelines recommend prophylactic anticoagulation for all hospitalized patients with cancer to prevent hospital-acquired venous thromboembolism (VTE). However, adherence to these evidence-based recommended practice patterns remains low. We performed a quality improvement (QI) project to increase VTE pharmacologic prophylaxis rates among patients with gynecologic malignancies hospitalized for nonsurgical indications and evaluated the resulting effect on rates of development of VTE. MATERIALS AND METHODS: In June 2011, departmental VTE practice guidelines were implemented for patients with gynecologic malignancies who were hospitalized for nonsurgical indications. A standardized VTE prophylaxis module was added to the admission electronic order sets. Outcome measures included number of admissions receiving VTE pharmacologic prophylaxis within 24 hours of admission; and number of potentially preventable hospital-acquired VTEs diagnosed within 30 and 90 days of discharge. Outcomes were compared between a preguideline implementation cohort (n = 99), a postguideline implementation cohort (n = 127), and a sustainability cohort assessed 2 years after implementation (n = 109). Patients were excluded if upon admission they had a VTE, were considered low risk for VTE, or had a documented contraindication to pharmacologic prophylaxis. RESULTS: Administration of pharmacologic prophylaxis within 24 hours of admission increased from 20.8% to 88.2% immediately following the implementation of guidelines, but declined to 71.8% in our sustainability cohort (P < 0.001). There was no difference in VTE incidence among the 3 cohorts [n = 2 (4.2%) vs n = 3 (3.9%) vs n = 3 (4.2%), respectively; P = 1.00]. CONCLUSIONS: Our QI project improved pharmacologic VTE prophylaxis rates. A small decrease in prophylaxis during the subsequent 2 years suggests a need for continued surveillance to optimize QI initiatives. Despite increased adherence to guidelines, VTE rates did not decline in this high-risk population.
OBJECTIVE: National guidelines recommend prophylactic anticoagulation for all hospitalized patients with cancer to prevent hospital-acquired venous thromboembolism (VTE). However, adherence to these evidence-based recommended practice patterns remains low. We performed a quality improvement (QI) project to increase VTE pharmacologic prophylaxis rates among patients with gynecologic malignancies hospitalized for nonsurgical indications and evaluated the resulting effect on rates of development of VTE. MATERIALS AND METHODS: In June 2011, departmental VTE practice guidelines were implemented for patients with gynecologic malignancies who were hospitalized for nonsurgical indications. A standardized VTE prophylaxis module was added to the admission electronic order sets. Outcome measures included number of admissions receiving VTE pharmacologic prophylaxis within 24 hours of admission; and number of potentially preventable hospital-acquired VTEs diagnosed within 30 and 90 days of discharge. Outcomes were compared between a preguideline implementation cohort (n = 99), a postguideline implementation cohort (n = 127), and a sustainability cohort assessed 2 years after implementation (n = 109). Patients were excluded if upon admission they had a VTE, were considered low risk for VTE, or had a documented contraindication to pharmacologic prophylaxis. RESULTS: Administration of pharmacologic prophylaxis within 24 hours of admission increased from 20.8% to 88.2% immediately following the implementation of guidelines, but declined to 71.8% in our sustainability cohort (P < 0.001). There was no difference in VTE incidence among the 3 cohorts [n = 2 (4.2%) vs n = 3 (3.9%) vs n = 3 (4.2%), respectively; P = 1.00]. CONCLUSIONS: Our QI project improved pharmacologic VTE prophylaxis rates. A small decrease in prophylaxis during the subsequent 2 years suggests a need for continued surveillance to optimize QI initiatives. Despite increased adherence to guidelines, VTE rates did not decline in this high-risk population.
Authors: Susan R Kahn; Wendy Lim; Andrew S Dunn; Mary Cushman; Francesco Dentali; Elie A Akl; Deborah J Cook; Alex A Balekian; Russell C Klein; Hoang Le; Sam Schulman; M Hassan Murad Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: Michael K Gould; David A Garcia; Sherry M Wren; Paul J Karanicolas; Juan I Arcelus; John A Heit; Charles M Samama Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: Ramón Lecumberri; Margarita Marqués; Elena Panizo; Ana Alfonso; Alberto García-Mouriz; Ignacio Gil-Bazo; José Hermida; Sam Schulman; José A Páramo Journal: Thromb Haemost Date: 2013-05-16 Impact factor: 5.249
Authors: Kathleen M Schmeler; Ginger L Wilson; Katherine Cain; Mark F Munsell; Pedro T Ramirez; Pamela T Soliman; Alpa M Nick; Michael Frumovitz; Robert L Coleman; Michael H Kroll; Charles F Levenback Journal: Gynecol Oncol Date: 2012-11-28 Impact factor: 5.482
Authors: Susan R Kahn; David R Morrison; Jacqueline M Cohen; Jessica Emed; Vicky Tagalakis; Andre Roussin; William Geerts Journal: Cochrane Database Syst Rev Date: 2013-07-16
Authors: Gary H Lyman; Alok A Khorana; Nicole M Kuderer; Agnes Y Lee; Juan Ignacio Arcelus; Edward P Balaban; Jeffrey M Clarke; Christopher R Flowers; Charles W Francis; Leigh E Gates; Ajay K Kakkar; Nigel S Key; Mark N Levine; Howard A Liebman; Margaret A Tempero; Sandra L Wong; Ann Alexis Prestrud; Anna Falanga Journal: J Clin Oncol Date: 2013-05-13 Impact factor: 44.544