Educational outreach visits to improve venous thromboembolism prevention in hospitalised medical patients: a prospective before-and-after intervention study
Duff, J and Omari, A and Middleton, S and McInnes, E and Walker, K, Educational outreach visits to improve venous thromboembolism prevention in hospitalised medical patients: a prospective before-and-after intervention study, BMC Health Services Research, 13, (398) pp. 1-9. ISSN 1472-6963 (2013) [Refereed Article]
Copyright 2013 Duff et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Background: Despite the availability of evidence-based guidelines on venous thromboembolism (VTE) prevention
clinical audit and research reveals that hospitalised medical patients frequently receive suboptimal prophylaxis. The
aim of this study was to evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV)
on the provision of VTE prophylaxis to hospitalised medical patients in a 270 bed acute care private hospital in
Methods: The study used an uncontrolled before-and-after design with accompanying process evaluation. The
acceptability of the intervention to participants was measured with a post intervention survey; descriptive data on
resource use was collected as a measure of utility; and clinical impact (prophylaxis rate) was assessed by pre and
post intervention clinical audits. Doctors who admit >40 medical patients each year were targeted to receive the
intervention which consisted of a one-to-one educational visit on VTE prevention from a trained peer facilitator. The
EOV protocol was designed by a multidisciplinary group of healthcare professionals using social marketing theory.
Results: Nineteen (73%) of 26 eligible participants received an EOV. The majority (n = 16, 85%) felt the EOV was
effective or extremely effective at increasing their knowledge about VTE prophylaxis and 15 (78%) gave a verbal
commitment to provide evidence-based prophylaxis. The average length of each visit was 15 minutes (IQ range 15
to 20) and the average time spent arranging and conducting each visit was 92 minutes (IQ range 78 to 129). There
was a significant improvement in the proportion of medical patients receiving appropriate pharmacological VTE
prophylaxis following the intervention (54% to 70%, 16% improvement, 95% CI 5 to 26, p = 0.004).
Conclusions: EOV is effective at improving doctorsí provision of pharmacological VTE prophylaxis to hospitalised
medical patients. It was also found to be an acceptable implementation strategy by the majority of participants;
however, it was resource intensive requiring on average 92 minutes per visit.
Keywords: Educational outreach visit, Implementation science, Venous thromboembolism prevention