Scorecard implementation improves identification of postpartum patients at risk for venous thromboembolism

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Abstract

Objective:

To evaluate if an intensive educational intervention in the use of a standardized venous thromboembolism (VTE) risk assessment tool (scorecard) improves physicians' identification and chemoprophylaxis of postpartum patients at risk for VTE.

Methods:

After implementation of a VTE scorecard and prior to an intensive educational intervention, postpartum patients (n= 140) were evaluated to assess scorecard completion, risk factors, and chemoprophylaxis. A performance improvement campaign focusing on patient safety, VTE prevention, and scorecard utilization was then conducted. Evaluation of the same parameters was subsequently performed for a similar group of patients (n= 133). Differences in scorecard utilization and risk assessment were tested for statistical significance.

Results:

Population-at-risk rates were similar in both assessment periods (31.4% vs 28.6%;p= NS). The greatest risk factors included cesarean delivery, body mass index (BMI) >30 and age >35. Scorecard completion rates for all patients increased in the postintervention period (15.7% vs 67.7%;p< .001). Postintervention scorecard completion rates for the at-risk population also improved (20% vs 79%;p< .001). In the postintervention group, those at risk with completed scorecards had higher prophylaxis rates than those at risk without scorecards (73% vs 25%;p= .03). At-risk patients with completed scorecards had 2.6 times more orders for chemoprophylaxis than at-risk patients without scorecards in both time periods (odds ratio [OR] = 8.4; 95% confidence interval [CI] 3.1–22.8).

Conclusion:

Utilization of a VTE scorecard coupled with an educational intervention for health care providers increases detection and chemoprophylaxis orders for at-risk patients. Encouraging universal scorecard assessment standardizes identification and chemoprophylaxis of at-risk patients who were otherwise not perceived to be at risk.

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