Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial

Autor: Nancy S. Lloyd, Menaka Pai, Holger J. Schünemann, Frederick A. Spencer, Ji Cheng, James D. Douketis, R. Brian Haynes, Lehana Thabane, Deborah J. Cook
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Male
Medical Records
Health administration
law.invention
0302 clinical medicine
Randomized controlled trial
law
030212 general & internal medicine
Cluster randomised controlled trial
Aged
80 and over
Medicine(all)
lcsh:R5-920
Medical Errors
030503 health policy & services
Health Policy
Medical record
Health services research
Professional Practice
General Medicine
Middle Aged
3. Good health
Hospitalization
Practice Guidelines as Topic
Cluster randomization
Female
Guideline Adherence
0305 other medical science
Risk assessment
lcsh:Medicine (General)
Venous thromboembolism
Adult
medicine.medical_specialty
Blinding
Adolescent
Health Informatics
Unnecessary Procedures
Young Adult
03 medical and health sciences
Medical patients
Standard orders
medicine
Humans
Intensive care medicine
Thromboprophylaxis
Aged
Heparin
business.industry
Research
Public Health
Environmental and Occupational Health
Anticoagulants
Odds ratio
Epidemiologic Methods
business
Zdroj: Implementation Science, Vol 8, Iss 1, p 1 (2013)
Implementation Science : IS
ISSN: 1748-5908
Popis: Background Venous thromboembolism (VTE) is a common preventable cause of mortality in hospitalized medical patients. Despite rigorous randomized trials generating strong recommendations for anticoagulant use to prevent VTE, nearly 40% of medical patients receive inappropriate thromboprophylaxis. Knowledge-translation strategies are needed to bridge this gap. Methods We conducted a 16-week pilot cluster randomized controlled trial (RCT) to determine the proportion of medical patients that were appropriately managed for thromboprophylaxis (according to the American College of Chest Physician guidelines) within 24 hours of admission, through the use of a multicomponent knowledge-translation intervention. Our primary goal was to determine the feasibility of conducting this study on a larger scale. The intervention comprised clinician education, a paper-based VTE risk assessment algorithm, printed physicians’ orders, and audit and feedback sessions. Medical wards at six hospitals (representing clusters) in Ontario, Canada were included; three were randomized to the multicomponent intervention and three to usual care (i.e., no active strategies for thromboprophylaxis in place). Blinding was not used. Results A total of 2,611 patients (1,154 in the intervention and 1,457 in the control group) were eligible and included in the analysis. This multicomponent intervention did not lead to a significant difference in appropriate VTE prophylaxis rates between intervention and control hospitals (appropriate management rate odds ratio = 0.80; 95% confidence interval: 0.50, 1.28; p = 0.36; intra-class correlation coefficient: 0.022), and thus was not considered feasible. Major barriers to effective knowledge translation were poor attendance by clinical staff at education and feedback sessions, difficulty locating preprinted orders, and lack of involvement by clinical and administrative leaders. We identified several factors that may increase uptake of a VTE prophylaxis strategy, including local champions, support from clinical and administrative leaders, mandatory use, and a simple, clinically relevant risk assessment tool. Conclusions Hospitals allocated to our multicomponent intervention did not have a higher rate of medical inpatients appropriately managed for thromboprophylaxis than did hospitals that were not allocated to this strategy.
Databáze: OpenAIRE
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