Comprehensive Initiative to Decrease Trauma Venous Thromboembolism

Abstract

Background: Our trauma center was a high outlier for pulmonary embolism on a 2017 American College of Surgeons Trauma Quality Improvement Program (TQIP) report. The odds ratio for developing a pulmonary embolus was 1.76 and was in the 10th decile (worst results). Of the patients who received chemoprophylaxis, only 69% of patients received the "gold standard" low-molecular-weight heparin.

Objective: The purpose of this study was to describe and evaluate a multicomponent performance improvement project to prevent pulmonary embolus incidence.

Methods: This descriptive study was a before-and-after time-series analysis of adult trauma patients. Ongoing data validation, concurrent monitoring, and analysis on incidence of venous thrombolytic events identified barriers to evidence-based chemoprophylaxis administration.

Results: There were a total of 4,711 trauma patients in the analysis. Compared with preintervention (fall 2017), the fall 2019 TQIP report indicated the pulmonary embolus odds ratio dropped to 0.56, lowering the benchmark decile from 10 (worst) to 1 (best). The proportion of patients receiving no chemoprophylaxis decreased to 23% and was lower than all hospitals (32%). The rate of low-molecular-weight heparin use increased to 80% for patients receiving chemoprophylaxis, and unfractionated heparin use plummeted to 14%. The proportion of patients with no chemoprophylaxis in the severe traumatic brain injury cohort fell to 21%.

Conclusions: The high pulmonary embolus rate was driven by inaccurate data, infrequent monitoring, suboptimal ordering, and administration of chemoprophylaxis. A sustained decrease in the pulmonary embolus incidence was achieved through collaboration, updated guidelines, expanded education, concurrent validation, monitoring, and frequent reporting.