Category: Health Policy and Systems
Deep Venous Thromboembolism (DVT) prophylaxis is an important aspect of the medical management of a patient in an Inpatient Rehabilitation setting. Practice shows that it is often omitted in the transition of care from an acute hospital to the Inpatient Rehabilitation. The aim of the study is to improve the rate of chemical DVT prophylaxis coverage by including the previous regiment in the preadmission screen.
A historical cohort study of all 729 patients admitted to an acute inpatient rehabilitation center with a diagnosis of Stroke or Traumatic Brain Injury (TBI) from March 2018 to July 2019. Including DVT prophylaxis regiment during acute hospitalization in the pre-admission screen was implemented on May 20th, 2019.
Pre-intervention 647 patients with a diagnosis of Stroke or TBI were admitted to the Inpatient Rehabilitation. Based on the Medication Reconciliation from the acute hospital 475 (73%) patients were placed on chemical DVT prophylaxis, 172 (27%) were placed on mechanical prophylaxis only. In the mechanical prophylaxis group, chemical prophylaxis was appropriately contraindicated due to major bleeding in 127 (20%) of the patients, however, for 45 (7%) of the patients, the chemical prophylaxis was inappropriately stopped on discharge.
The rate of DVT in the group that was on chemical prophylaxis since admission was 4.84%, the rate of DVT in the group that had an appropriate contraindication was 10.24%, the rate of DVT in the group that the regiment was inappropriately stopped was 8.89%.
The intervention was applied to 81 patients. There was a 50% decrease in the rate of patients for whom the chemical DVT prophylaxis was inappropriately stopped during discharge.
Prophylaxis for DVT is an important aspect of the medical management of a patient in an Inpatient Rehabilitation setting. Including pre-admission DVT prophylaxis regimen may improve the transition of care and lower the rate of DVT.
Olga Komargodski– Resident Physician, St. Charles Hospital
Andrew McElroy– Resident, St. Charles Hospital and Rehabilitation Center
Claudia Echaide– Research Coordinator, St. Charles Hospital and Rehabilitation Center
Jun Zhang– Attending Physician, St. Charles Hospital