PA-driven VTE risk assessment improves compliance with recommended prophylaxis

Area of Science:

• Medical Research
• Health Systems Improvement
• Surgical Patient Care

Background:

• Venous thromboembolism (VTE) poses a significant risk of morbidity and mortality in hospitalized, especially surgical, patients.
• Adherence to established VTE prophylaxis guidelines is crucial for patient safety in surgical settings.

Purpose of the Study:

• To evaluate the effectiveness of Physician Assistants (PAs) in implementing and improving VTE prophylaxis adherence among general surgical patients.
• To assess the impact of a PA-driven VTE risk assessment and prophylaxis intervention on reducing in-hospital VTE events.

Main Methods:

• Retrospective cohort study of 2,046 general surgical patients (July 2005-June 2007) at the University of Michigan.
• Implementation of a PA-led VTE risk assessment and prophylaxis intervention in June 2006.
• Comparison of VTE prophylaxis orders and VTE event rates (deep vein thrombosis/pulmonary embolism) between pre- and post-intervention periods using ICD-9-CM codes.

Main Results:

• Appropriate VTE prophylaxis orders for high-risk patients (risk score ≥3) increased from 23.1% pre-intervention to 63.7% post-intervention.
• For highest-risk patients (risk score ≥5), prophylaxis orders rose from 29.4% to 69.5%.
• No significant differences in case mix were observed between the pre- and post-intervention groups.

Conclusions:

• A PA-driven VTE risk assessment process significantly enhanced the prescription of guideline-adherent VTE prophylaxis in surgical patients.
• This intervention demonstrated a substantial improvement in VTE prophylaxis management within the health system, tailored to individual patient risk.