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Changing Practice: Implementation of a Venous Thromboembolism Prophylaxis Protocol at an Academic Medical Center

Pannucci, Christopher J. M.D., M.S.; Jaber, Reda M. B.S.; Zumsteg, Justin M. M.D.; Golgotiu, Vlad B.S.; Spratke, Lisa M. P.A.-C.; Wilkins, Edwin G. M.D., M.S.

doi: 10.1097/PRS.0b013e31822b67ff
Reconstructive: Trunk: Original Articles

Background: The Institute of Medicine has identified a “quality chasm” between existing evidence and actual clinical practice. The Venous Thromboembolism Prevention Study has shown that enoxaparin prophylaxis is a safe and effective way of preventing postoperative venous thromboembolism. This article presents a “how-to” guide for implementation of a venous thromboembolism prophylaxis protocol.

Methods: The Venous Thromboembolism Prevention Study prophylaxis protocol included provision of postoperative, prophylactic dose enoxaparin for the duration of inpatient stay. Compliance was considered at the individual patient level and defined as appropriate provision of protocol-appropriate enoxaparin prophylaxis. Multiple simultaneous interventions to improve protocol compliance were undertaken. Both physician and physician assistant “champions” were identified. Interventions included staff and surgeon educational sessions, discussion of venous thromboembolism–themed articles at journal club, and monthly e-mail reminders specific to the protocol, among others. Compliance rates over time were compared using the chi-square test.

Results: The authors reviewed medical records from 945 consecutive admissions to the plastic surgery service who met Venous Thromboembolism Prevention Study eligibility criteria over a 30-month period. Initial education sessions significantly increased compliance over baseline (55 percent versus 10 percent; p < 0.001). After formal protocol adoption, compliance increased steadily over the first 9 months and peaked by 1 year. In the absence of any direct intervention, compliance remained stable at 90 percent for the final 12 months of the study. This was significantly increased when compared with the period of time immediately following protocol adoption (90 percent versus 77 percent; p < 0.001).

Conclusion: This article provides readers with a practical approach for implementation of a venous thromboembolism prophylaxis protocol at their hospital.

Ann Arbor, Mich.; and Nashville, Tenn.

From the Section of Plastic Surgery, University of Michigan, and the Department of Orthopaedics and Rehabilitation, Vanderbilt University.

Received for publication April 5, 2011; accepted April 19, 2011.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. Dr. Pannucci receives salary support from the National Institutes of Health T32 grant program (T32 GM-08616).

Christopher J. Pannucci, M.D., M.S.; Section of Plastic Surgery, Department of Surgery, 2130 Taubman Center, Box 0340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109,

©2011American Society of Plastic Surgeons