Improving SCD compliance in trauma patients at Kings County Hospital Center: a quality improvement report

Abstract

Venous thromboembolism (VTE) is the fourth most commonly reported complication in trauma patients. For these patients, thromboprophylaxis is a standard of care. Patient compliance with sequential compression devices (SCDs), a form of mechanical VTE prophylaxis, has been a focus of efforts to improve patient safety. At our institution, a baseline audit in July 2020 revealed that patients admitted to the trauma floors have poor compliance with the use of SCDs. In this quality improvement project, we developed a patient education intervention to improve SCD compliance. We distributed an informational flyer to patients and led short educational sessions on VTE risk factors and proper SCD use. Our aim was to increase our SCD compliance rate by 30% in 4 weeks. We used three plan-do-study-act (PDSA) cycles to implement and refine our intervention. We measured SCD compliance during morning and afternoon patient observations and generated run charts to understand how our cycles were leading to change. After a 4-week period, we did not achieve our aim, but increased our overall compliance from 45% to 60% and sustained this improvement throughout our PDSA cycles. Morning compliance was lower than afternoon compliance both at baseline (45% vs 48.5%) and at the end the project (45% vs 53%). Our results suggest that patient education should be coupled with interventions that address other barriers to SCD compliance.

Keywords: PDSA; patient education; quality improvement; surgery; venous thromboembolism.

Figure 1

Patient education flyer on VTE risk factors and proper sequential compression device (SCD) use. Flyer was distributed to each patient as part of our patient education intervention. Flyer was available in English, Spanish, and Haitian Creole. MI, myocardial infarcation.

Figure 2

Run chart of SCD compliance rates. The green lines represent goal compliance rate (75%) and the orange lines represent the median compliance rate. (A) Run chart of morning and afternoon SCD compliance rates. Beginning at 7/21, a shift occurred in the dataset, increasing the median from 45% to 60%. No further shifts were observed. (B) Run chart of morning SCD compliance rates. No shifts were observed in the dataset. (C) Run chart of afternoon SCD compliance rates. At 7/21, a shift occurred in the dataset, increasing the median from 48.5% to 64.5%. At 7/27, a second shift occurred, decreasing the median from 64.5% to 53%. No further shifts were observed. PDSA, plan-do-study-act; SCD, sequential compression device.