Implementation of a Prophylactic Anticoagulation Guideline for Patients with Traumatic Brain Injury
Autor: | Cori Sybrant, Simon Yang, Patty Reicks, Jonathan Gipson, Melissa Thorson, Arthur S. Nguyen, Robert Roach, Regina Martinez, Christopher J. Tignanelli, Michael West |
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Rok vydání: | 2020 |
Předmět: |
Protocol (science)
medicine.medical_specialty Quality management Leadership and Management Traumatic brain injury business.industry 030503 health policy & services MEDLINE Anticoagulants Venous Thromboembolism Audit Benchmarking Guideline medicine.disease Quality Improvement 03 medical and health sciences 0302 clinical medicine Brain Injuries Traumatic Emergency medicine medicine Humans In patient 030212 general & internal medicine 0305 other medical science business |
Zdroj: | The Joint Commission Journal on Quality and Patient Safety. 46:185-191 |
ISSN: | 1553-7250 |
Popis: | Patients with traumatic brain injury (TBI) are at an increased risk of developing complications from venous thromboembolisms (VTEs [blood clots]). Benchmarking by the American College of Surgeons Trauma Quality Improvement Program identified suboptimal use of prophylactic anticoagulation in patients with TBI. We hypothesized that institutional implementation of an anticoagulation protocol would improve clinical outcomes in such patients.A new prophylactic anticoagulation protocol that incorporated education, weekly audits, and real-time adherence feedback was implemented in July 2015. The trauma registry identified patients with TBI before (PRE) and after (POST) implementation. Multivariable regression analysis with risk adjustment was used to compare use of prophylactic anticoagulation, VTE events, and mortality.A total of 681 patients with TBI (368 PRE, 313 POST) were identified. After implementation of the VTE protocol, more patients received anticoagulation (PRE: 39.4%, POST: 80.5%, p0.001), time to initiation was shorter (PRE: 140 hours, POST: 59 hours, p0.001), and there were fewer VTE events (PRE: 19 [5.2%], POST: 7 [2.2%], p = 0.047). Multivariable analysis showed that POST patients were more likely to receive anticoagulation (odds ratio [OR] = 10.8, 95% confidence interval [CI] = 6.9-16.7, p0.001) and less likely to develop VTE (OR = 0.33, 95% CI = 0.1-1.0, p = 0.05).Benchmarking can assist institutions to identity potential clinically relevant areas for quality improvement in real time. Combining education and multifaceted protocol implementation can help organizations to better focus limited quality resources and counteract barriers that have hindered adoption of best practices. |
Databáze: | OpenAIRE |
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