The effect of a continuing medical education program on Venous thromboembolism prophylaxis utilization and mortality in
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ORIGINAL CLINICAL INVESTIGATION
Open Access
The effect of a continuing medical education program on Venous thromboembolism prophylaxis utilization and mortality in a tertiary-care hospital Fahad Al-Hameed1,2*, Hasan M Al-Dorzi3 and Essam Aboelnazer4
Abstract Background: Venous thromboembolism (VTE) prophylaxis is underutilized for hospitalized patients. The primary objective of this study was to assess the impact of a continuing medical education (CME) program on thromboprophylaxis and VTE-associated mortality in a tertiary-care hospital. Methods: This was a retrospective study of all patients admitted to a tertiary-care hospital from 01/07/2009 to 30/ 06/2010 (after a CME program that aimed at improving VTE prophylaxis) and had confirmed VTE during stay. VTE prophylaxis utilization and associated mortality were assessed in them and compared to those of a similar cohort of patients hospitalized in the previous 12 months. Results: There were 147 confirmed VTE cases in the study period (surgical: 26.5% and medical: 73.5%). Most (63.9%) VTE patients received prophylaxis after the CME program compared with 36.5% in the previous 12 months (relative risk 1.73; 95% confidence interval, 1.38-2.18; P < 0.001). More surgical (82.1%) than medical (57.4%) patients received prophylaxis (P < 0.01). VTE-associated mortality rate was 10.9% with a significant decrease after the CME program (relative risk, 0.52; 95% confidence interval, 0.30-0.90). This mortality was lower for those who received VTE prophylaxis compared to those who didn’t (4.3% and 22.6%, respectively; P < 0.01). Additionally, VTE-associated deaths represented 1.1% of total hospital mortality compared to 1.9% in the 12 months before CME program (relative risk, 0.58; 95% confidence interval, 0.32-1.04; P = 0.07). Conclusions: A CME educational program to improve VTE prophylaxis in a tertiary-care hospital was associated with improvement in VTE prophylaxis utilization and VTE-associated mortality. Such programs are highly recommended. Keywords: Venous thromboembolism, Deep venous thrombosis, Pulmonary embolism, Thromboprophylaxis, Continuing medical education
Background Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalized patients, accounting for 5-10% of in-hospital fatalities [1,2]. Although thromboprophylaxis has been proven to be effective [3,4], it continues to be underemployed. In the “Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care
* Correspondence: [email protected] 1 Department of Intensive Care, King Abdul-Aziz Medical City; College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, National Guard Health Affairs, Jeddah, Saudi Arabia 2 Saudi Association for Venous Thromboembolism (SAVTE), Jeddah, Saudi Arabia Full list of author information is available at the end of the article
Setting” (ENDORSE) study, a multi-national and multicenter cross-sectional survey, only about half of hospitalized patients received thro
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