Medical Inspection – Health Blog

Data for 100 patients meeting the inclusion criteria (and not excluded by the exclusion criteria) were reviewed: 20 patients each in the vascular, general, and cardiac surgery groups, 18 patients who had undergone prostatectomy, and 22 patients who had undergone major urological surgery. The mean age of patients was 68 years (range 40 to 87 years), and 74% were men. The mean length of the hospital stay was 6.9 days (range 2 to 30 days). The mean number of risk factors per patient was 3. The most common risk factors, aside from surgery and age over 40 years, were malignancy (25%), obesity (24%), and central venous catheterization (19%). Seventy-four of the patients had undergone major surgery.

Table 3. Outcomes of Clinical Audit of Adherence to Protocol for Prophylaxis of Venous Thromboembolism

Thromboprophylaxis was used for 82% of the patients (Table 3). However, only 29% of the patients had received therapy that corresponded to their risk of venous thromboembolism. Failure to appropriately stratify a patient’s risk accounted for 58% (41/71) of those receiving inadequate therapy (Table 4). All of these patients had an anticoagulation regimen appropriate for a risk level lower than their assessed risk. No patients received a thromboprophylactic regimen appro­priate for a risk level higher than their assessed risk.Secondary outcomes were also considered. Two patients experienced clinically evident venous thromboembolism during their hospital stay. The first of these patients experienced pulmonary embolism after a prostatectomy, which prolonged the hospital stay from about 4 days to 30 days. According to the chart review, the patient had not received any thromboprophylaxis after the surgical procedure. The second patient experienced deep vein thrombosis after a major urological procedure. This patient had received thromboprophylaxis; however, it did not correspond to the regimen recommended in the prophylaxis protocol, as the patient’s risk had been stratified to a lower level than what the chart information alone might have indicated. This patient’s hospital stay was prolonged from approximately 4 days to 11 days. In both of these cases, it is important to recognize that the treating clinicians might have taken into consideration other factors that were not apparent in the chart. Minor hemorrhage (not requiring re-operation or transfusion) was reported for 7% of the patients (Table 3). Despite these minor hemorrhages, the patients continued to receive thromboprophylaxis. For all patients, there was sufficient information in the chart (type of surgery, age, height, and weight) to stratify risk according to the 4 defined levels.
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Table 4. Reasons for Inadequate Thromboprophylaxis

Related Posts:

• Retrospective Clinical Audit of Adherence to a Protocol: DISCUSSION part 2
• Retrospective Clinical Audit of Adherence to a Protocol: DISCUSSION
• Retrospective Clinical Audit of Adherence to a Protocol: METHODS
• Retrospective Clinical Audit of Adherence to a Protocol