Improving venous thromboembolism prevention in hospitalised medical patients: Evaluating the acceptability, utility and clinical impact of educational outreach visits

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.

Aim: To evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV) on the provision of VTE prophylaxis to hospitalised medical patients.

Method: Participants received a one-to-one EOV on VTE prevention from a trained peer (doctor or nurse) facilitator. 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.

Results: 85 nurses (71%) and 19 doctors (73%) received an EOV. The median length of each visit was 11.5 min (IQR 10-15) for nurses and 15 min (IQR 15-20) for doctors. The total time spent arranging and conducting each visit was 63 minutes (IQR 49-85) for nurses and 92 min (IQR 78-129) for doctors. 97.4% (n=84) of nurses and 85% (n=16) of doctors surveyed post intervention felt that the EOV was effective or extremely effective and 84 (98.8%) nurses and 15 (78%) doctors gave a verbal commitment to trial the new evidence-based practices. There was no measurable improvement in the proportion of patients provided appropriate mechanical prophylaxis (-0.3% improvement, 95% CI -13.4 to 14, p=0.96). There was a significant improvement in the proportion of patients receiving appropriate pharmacological prophylaxis following the intervention (16% improvement, 95% CI 5 to 26, p=0.004).

Conclusion: EOV is resource intensive but it is one of the few interventions that have been consistently shown to influence doctors prescribing practices. The cost of the intervention must therefore be weighed against the potential benefits it can achieve.