International Journal for Quality in Health Care Advance Access originally published online on October 18, 2005
International Journal for Quality in Health Care 2006 18(2):123-126; doi:10.1093/intqhc/mzi083
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Quality in Practice
Prevention of perioperative venous thromboembolism and coronary events: differential responsiveness to an intervention program to improve guidelines adherence
1 Faculty of Medicine, Hebrew University of Jerusalem, Israel, 2 Department of Anesthesiology, Hadassah Hebrew-University Hospital, Ein Kerem Campus, Jerusalem, Israel, 3 Department of Hematology, Hadassah Hebrew-University Hospital, Ein Kerem Campus, Jerusalem, Israel, 4 Adult Echocardiography Laboratory, The Heart Institute, Hadassah Hebrew-University Hospital, Ein Kerem Campus, Jerusalem, Israel, 5 Department of Obstetrics and Gynecology, Hadassah Hebrew-University Hospital, Ein Kerem Campus, Jerusalem, Israel, 6 Department of Surgery, Hadassah Hebrew-University Hospital, Ein Kerem Campus, Jerusalem, Israel and 7 Quality & Safety Committee, Hadassah Hebrew-University Hospital, Ein Kerem Campus, Jerusalem, Israel
Introduction. Prevention of venous thromboembolism and coronary events (with ß-blockers) during and after surgery is at the top of a list of safety practices for hospitalized patients, recommended by the Agency for Health Care Research and Quality (AHRQ). We wished to determine and improve adherence to clinical guidelines for these topics in our institution.
Patients, material, and methods. A prospective survey was conducted over several weeks on operated patients in a 1200-beds medical center (a teaching, community and referral hospital in Jerusalem, Israel). Eligibility for and actual administration of prophylactic treatment with anticoagulant and ß-blockers were determined. Following an intervention program, which included staff meetings, development of local protocols, and academic detailing by a nurse, the survey was repeated.
Results. In general, adherence to recommended anticoagulation prophylaxis was low, found in only 29% [95% confidence interval (CI) = 23–36] of eligible patients. After the intervention, adequate anticoagulation increased to 50% (95% CI = 40–59) of eligible patients (P < 0.001). Initiation of ß-blockers in preventing perioperative cardiac events was very low (0%, 95% CI = 0–5%) and did not increase after intervention.
Conclusions. Adherence to guidelines for prevention of surgical complications was found to be low in our institution. A multifaceted intervention significantly increased use of prophylaxis for venous thromboembolism but not for coronary events. This differential response suggests that the success of a quality improvement project strongly depends on topic content and its phase of acceptance.
Keywords: academic detailing, barriers to quality improvement, beta blockers, diffusion of innovations, guidelines adherance, thromboembolism prophylaxis
Address reprint requests to M. Brezis, Center for Clinical Quality & Safety, Hadassah Hebrew-University Hospital, Ein-Kerem, PO Box 12000, Jerusalem 91120, Israel. E-mail: brezis{at}vms.huji.ac.il
Accepted for publication September 18, 2005.