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Comprehensive Initiative to Decrease Trauma Venous Thromboembolism.

Tracy J Johns1, Josephine Fabico-Dulin, Anne Montgomery

  • 1Trauma Services Department, Atrium Health Navicent, Macon, Georgia (Mss Johns, Fabico-Dulin, and Dulin and Dr Ashley); and Community Health Department, Mercer University School of Medicine, Macon, Georgia (Dr Montgomery).

Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses
|July 2, 2021
PubMed
Summary
This summary is machine-generated.

A performance improvement project significantly reduced pulmonary embolism (PE) rates in trauma patients. The project improved chemoprophylaxis use, lowering PE incidence from a high outlier to the best benchmark decile.

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Area of Science:

  • Trauma Surgery
  • Quality Improvement
  • Patient Safety

Background:

  • Trauma center identified as a high outlier for pulmonary embolism (PE) incidence in 2017 TQIP report.
  • Odds ratio for PE was 1.76 (10th decile); only 69% of patients received low-molecular-weight heparin (LMWH).

Purpose of the Study:

  • To describe and evaluate a multicomponent performance improvement project aimed at preventing PE incidence in trauma patients.

Main Methods:

  • Descriptive study utilizing a before-and-after time-series analysis of adult trauma patients.
  • Ongoing data validation, concurrent monitoring, and analysis of venous thromboembolic events to identify barriers to evidence-based chemoprophylaxis.

Main Results:

  • Pulmonary embolism odds ratio decreased from 1.76 to 0.56 (10th to 1st decile) by fall 2019.
  • Proportion of patients receiving no chemoprophylaxis decreased to 23% (vs. 32% benchmark).
  • LMWH use increased to 80% for patients receiving chemoprophylaxis; unfractionated heparin use decreased to 14%.

Conclusions:

  • High PE rates were linked to data inaccuracies, infrequent monitoring, and suboptimal chemoprophylaxis.
  • Sustained PE incidence reduction achieved through collaboration, updated guidelines, education, and enhanced monitoring/reporting.