From the 2018 HVPAA National Conference
Preston Kerr (UTMB), Ali Mohammad (UTMB), Jennifer Espinales (UTMB), Megan Swonke (BS), Paula Townley (UTMB), Gulshan Sharma (UTMB), Stephen Williams (UTMB)
Background
Sequential compression devices (SCDs) are routinely used for venous thromboembolism (VTE) prophylaxis. Current guidelines recommend SCD use in specific orthopedic populations or when bleeding risks prohibit pharmacologic prophylaxis.
Objectives
We sought to define utilization patterns and potential quality of care predictors regarding SCD use at our institution.
Methods
A cross-sectional study was performed by randomly sampling patients admitted to a single university hospital across three separate days from December 1, 2017 to January 31, 2018. Patients in the emergency department and pediatric units were excluded from our sampling. Data extraction included chart abstraction combined with direct patient observation. Univariate and chi-square analyses were performed.
Results
A total of 480 of 693 (69.3%) admitted patients were randomly selected and surveyed over three separate days. Mean age was 60.0 years (SD: 16.4) with 248 (56.8%), 106 (24.3%) and 83 (19.0%) patients sampled from medical, intensive care, and surgical units, respectively. A total of 241 (55.2%) patients had pharmacologic prophylaxis with 15 (3.4%) and 6 (1.4%) patients having a prior and current history of VTE upon admission, respectively. While 238 (49.6%) patients had an SCD order, only 51 (24.1%) patients had appropriate use of SCDs (p<0.001). Of patients with an SCD order, only 62 (33.3%) had an SCD machine in the room (p<0.001). Appropriate use of SCD stratified by unit were observed in 132 (53.2%), 51 (48.1%) and 19 (22.9%) patients on medical, intensive care and surgical units, respectively (p<0.001).
Conclusion
We observed heterogeneity in SCD use across medical, intensive care, and surgical units with up to 75% patients at-risk for inappropriate use when SCD orders are in place. This represents a high value based care SCD utilization initiative at our institution which is currently underway.
Implications for the Patient
The results of this study has initiated an intervention initiative within our hospital system to create a standardized framework to appropriately use mechanical prophylaxis in the prevention of VTEs. This will help us deliver high quality evidence based care without compromising outcomes or value.
