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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
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A Roadmap to Implementing Venous Thromboembolism Risk Stratification and Mitigation.
Gabriella E Glassman1, Michael Z Zhang2, James R Patrinely2
1From the Department of Plastic Surgery, Vanderbilt University Medical Center.
Annals of Plastic Surgery
|August 13, 2021
Summary
Implementing a modified Caprini risk assessment for venous thromboembolism (VTE) in outpatient plastic surgery significantly improved protocol compliance. Tailoring the VTE prophylaxis protocol to institutional workflow is key for successful patient safety initiatives.
Area of Science:
- Plastic Surgery
- Thrombosis Research
- Patient Safety
Background:
- Venous thromboembolism (VTE) poses a significant risk for plastic surgery patients, impacting morbidity and mortality.
- Despite recommendations for VTE prophylaxis, successful implementation of protocols remains challenging.
- An academic center sought to reduce VTE burden through a structured risk assessment protocol for outpatient procedures.
Purpose of the Study:
- To implement and assess the compliance of a modified Caprini risk assessment protocol for VTE in outpatient plastic surgery.
- To evaluate the impact of protocol modifications on screening compliance rates over a 12-month period.
Main Methods:
- A modified Caprini risk assessment was applied to all eligible outpatient plastic surgery patients over 12 months (August 2018-July 2019).
- Chart reviews were conducted monthly to assess compliance, defined as documented VTE Caprini screening.
- The study involved three phases, correlating protocol changes with compliance rates.
Main Results:
- Overall VTE Caprini screening compliance reached 44.8% over the 12-month study period.
- Compliance increased from 11.1% (initial visit screening) to 47.1% (day of surgery screening) and finally to 61.3% (electronic medical record integration).
- The median Caprini score for the patient population was 4, indicating a moderate risk.
Conclusions:
- Standardizing VTE risk assessment is crucial for enhancing patient safety and outcomes in plastic surgery.
- Adapting VTE prophylaxis protocols to institutional workflow and needs is essential for successful implementation and sustainability.
- Continuous review and modification of protocols are vital for maximizing departmental engagement and ensuring long-term success.
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