Implementing a Patient-Centered Education Bundle to Improve Venous Thromboembolism Prevention

Elliott R Haut^{1

2

3

4

5}, Oluwafemi P Owodunni⁶, Dauryne L Shaffer^{1

7}, Danielle McQuigg⁸, Deborah Samuel⁸, Deborah B Hobson^{1

4

7}, Peggy S Kraus⁹, Jiangxia Wang¹⁰, Kristen L W Webster¹¹, Mindy Kantsiper⁸, James E Harris Jr⁸, Christine G Holzmueller^{1

4}, Mujan Varasteh Kia¹², Michael B Streiff^{4

13}, Brandyn D Lau^{4

5

14}

Affiliations

¹ Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁴ Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.
⁵ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
⁶ Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico.
⁷ Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland.
⁸ Howard County General Hospital, Johns Hopkins Medicine, Baltimore, Maryland.
⁹ Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
¹⁰ Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
¹¹ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
¹² Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, Florida.
¹³ Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹⁴ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

PMID: 41060638
PMCID: PMC12509082 (available on 2026-10-08)
DOI: 10.1001/jamasurg.2025.4136

Implementing a Patient-Centered Education Bundle to Improve Venous Thromboembolism Prevention

Elliott R Haut et al. JAMA Surg. 2025.

. 2025 Oct 8:e254136.

doi: 10.1001/jamasurg.2025.4136. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁴ Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.
⁵ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
⁶ Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico.
⁷ Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland.
⁸ Howard County General Hospital, Johns Hopkins Medicine, Baltimore, Maryland.
⁹ Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
¹⁰ Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
¹¹ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
¹² Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, Florida.
¹³ Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹⁴ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

PMID: 41060638
PMCID: PMC12509082 (available on 2026-10-08)
DOI: 10.1001/jamasurg.2025.4136

Abstract

Importance: Venous thromboembolism (VTE) is one of the most common causes of preventable harm in hospitals. While numerous efforts have been made to increase prescription of evidence-based VTE prophylaxis for hospitalized patients, many prescribed doses are either refused or missed for other reasons. Successful interventions to decrease these missed doses have been developed and tested in academic hospitals, but it remains unclear if these interventions can be scaled and implemented in community hospitals.

Objective: To disseminate and implement an evidence-based, comprehensive strategy to reduce missed doses of VTE prophylaxis.

Design, setting, and participants: This prospective cohort study was conducted on 7 floors across a community hospital within a large health system. Participants were all hospitalized adult patients admitted from July 1, 2018, to June 30, 2019 (preintervention), and July 1 to December 31, 2019 (postintervention), who were prescribed at least 1 dose of pharmacologic VTE prophylaxis. Data analysis was performed from January 2020 to January 2022.

Interventions: Implementation of a dynamic, scenario-based nurse education module combined with a patient-centered education bundle triggered by a real-time alert sent to the charge nurse when a dose of prescribed VTE prophylaxis was not administered.

Main outcomes and measures: Primary outcome was the proportion of any missed doses of prescribed pharmacologic prophylaxis. Secondary outcomes were proportions of doses refused and missed for reasons other than refusal.

Results: A total of 15 752 patients were included, 8714 (55.3%) female and 7038 (44.7%) male. The mean (SD) age was 63.9 (18.5) years. Missed doses decreased significantly in the postimplementation period, 10 643 of 82 269 doses (12.9%) vs 2718 of 29 338 doses (9.3%) (OR, 0.60; 95% CI, 0.55-0.66). There were significant improvements in patient refusal (7280 doses [8.8%] vs 1696 doses [5.8%]; OR, 0.51; 95% CI, 0.46-0.58) and doses missed for reasons other than patient refusal (3363 [4.1%] vs 1022 [3.5%]; OR, 0.87; 95% CI, 0.77-0.99). There was no difference in the proportion of patients with VTE (9 patients [0.08%] vs 6 patients [0.1%]; P = .58).

Conclusion and relevance: This study found that providing engaging education to frontline nurses and just-in-time, patient-centered education to patients significantly improved administration and acceptance of prescribed VTE prophylaxis for hospitalized patients across an entire community hospital. These findings show that proven interventions developed at academic hospitals can be successfully implemented broadly in community hospitals.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Haut reported grants from the Agency for Healthcare Research and Quality (AHRQ, 1R01HS024547), Henry M. Jackson Foundation for the Advancement of Military Medicine, Department of Defense, and National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI, R21HL129028) and journal editor fees from Trauma Surgery & Acute Care Open outside the submitted work. Dr Owodunni reported research funding from AHRQ (1R01HS024547). Ms Shaffer reported grants from AHRQ and Patient-Centered Outcomes Research Institute (PCORI) outside the submitted work. Mrs Wang reported grants from NIH (U19AG033655: Biomarkers of Cognitive Decline Among Normal Individuals: the BIOCARD Cohort, and 1UM1TR004926-01: Institutional Clinical and Translational Research – UL Portion) during the conduct of the study. Dr Streiff reported research funding from AHRQ (1R01HS024547) and NIH/NHLBI (R21HL129028); research funding from Boehringer-Ingelheim, Janssen, Novo Nordisk, Roche and Sanofi outside the submitted work; consulting and/or data and safety monitoring board fees from Attralus, CSL Behring, Bristol Myers Squibb, Janssen, Portola, and Pfizer outside the submitted work; and having served as an expert witness for law firms in cases concerning venous thrombosis treatment and prevention. Dr Lau reported grants from AHRQ (1R01HS024547) and NIH/NHLBI (R21HL129028) outside the submitted work. No other disclosures were reported.

Comment in

doi: 10.1001/jamasurg.2025.4142

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Implementing a Patient-Centered Education Bundle to Improve Venous Thromboembolism Prevention

Affiliations

Implementing a Patient-Centered Education Bundle to Improve Venous Thromboembolism Prevention

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

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