Clinicians adopting evidence based guidelines: a case study with thromboprophylaxis

Area of Science:

• Medical Practice and Health Services Research
• Clinical Guideline Implementation
• Patient Safety and Quality Improvement

Background:

• Venous Thromboembolism (VTE) contributes to hospital mortality and incurs significant costs.
• Sub-optimal adoption of evidence-based VTE prophylaxis guidelines in hospitals is a persistent challenge.
• Understanding clinician attitudes and the clinical environment is crucial for improving VTE prevention.

Purpose of the Study:

• To explore clinician attitudes towards VTE prophylaxis guidelines.
• To identify barriers to the adoption of VTE prevention guidelines in clinical practice.
• To understand the influence of the clinical environment on guideline adherence.

Main Methods:

• In-depth qualitative interviews were conducted with 40 hospital doctors.
• Data were collected from two metropolitan hospitals in Australia between February and November 2009.
• Thematic analysis was applied to the qualitative data.

Main Results:

• Fragmented care delivery and shared responsibility for VTE prevention create barriers.
• A culture viewing medicine as an 'art' leads to guideline adaptation rather than universal application.
• Clinicians recommended clear responsibility allocation and reminders to improve VTE risk assessment.

Conclusions:

• Senior clinicians are pivotal in driving practice change for VTE prophylaxis.
• Demonstrating the value of guideline compliance to senior clinicians is essential.
• Organizational systems addressing care fragmentation and individual/cultural constraints are necessary for evidence-based practice.