Quality Initiative to Improve Compliance With Perioperative Anticoagulation

Area of Science:

• Gynecologic Oncology
• Surgical Patient Safety
• Pharmacology

Background:

• Venous thromboembolism (VTE) is a significant cause of complications in gynecologic oncology surgery.
• Neuraxial analgesia (NA) use complicates the timing of prophylactic anticoagulation, potentially increasing VTE risk.
• Preoperative anticoagulation guideline compliance was historically low (40%) in patients receiving NA.

Purpose of the Study:

• To implement a quality initiative (QI) to improve adherence to prophylactic anticoagulation guidelines.
• To increase compliance to 80% for NA cases and maintain 90% for non-NA cases.
• To reduce the incidence of VTE in surgical patients.

Main Methods:

• A multidisciplinary team developed and implemented a QI intervention bundle.
• Compliance was defined as receiving prophylactic anticoagulation within 1 hour of NA or before skin incision.
• Data from 100 QI cases were compared to 182 historical control cases.

Main Results:

• Overall compliance improved from 73% to 96% (P < .001).
• Compliance in NA cases significantly increased from 40% to 95% (P < .001).
• The overall VTE rate decreased from 2.1% to 0% (P = .3), though not statistically significant.

Conclusions:

• Simple, cost-effective QI initiatives can improve surgical pathway processes.
• Staff participation in QI projects is feasible and beneficial.
• These QI efforts can enhance patient safety by optimizing VTE prophylaxis.