Venous thromboembolism prophylaxis in emergency department admissions

Robert L. Levine, Georgene W. Hergenroeder, Charles C. Miller, Al Davies

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Guidelines for venous thromboembolism prophylaxis exist, yet prophylaxis is underutilized and inadequately studied in the context of emergency department admissions. Objective: This study aimed to measure the rate of venous thromboembolism prophylaxis in emergency department hospitalizations. Design: Prospective observational study. Setting: Urban, teaching hospital. Patients: Adult emergency department admissions. Intervention: Alternating admissions through the emergency department over 1 month were reviewed. Exclusion criteria were: requiring full anticoagulation, hemodialysis, length of stay less than 2 days, psychiatric admission, and primary physician declined review. An established risk assessment tool classified thromboembolism risk. Appropriate prophylaxis was defined as currently accepted medical or mechanical prophylaxis if in need or no prophylaxis if not indicated. Measurements: Factors associated with prophylaxis were considered significant if P < .05. Results: Of 254 patients, 201 (79%) had indications for prophylaxis, of whom 65 (32%) received it. Seventy-eight percent of prophylaxis orders were written in the first day of hospitalization. Factors related to increased use of prophylaxis included use of standard order sets (OR = 3, P < .009) and increased risk of venous thromboembolism (P < .0001). Factors related to underuse included primary cardiovascular diagnosis (OR = 0.18, P < .0001) and age (OR = 0.97, P < .0001). Eighteen of 26 patients admitted for whom standard order sets were used (69%) received appropriate prophylaxis (P = .01). Conclusions: Patients admitted through the emergency department are at high risk of venous thromboembolism. Despite this, venous thromboembolism prophylaxis is underutilized and rarely started after the first day of hospitalization. Use of admission standard order sets on admission from the emergency department may increase thromboembolic prophylaxis.

Original languageEnglish
Pages (from-to)79-85
Number of pages7
JournalJournal of Hospital Medicine
Volume2
Issue number2
DOIs
StatePublished - Mar 1 2007

Fingerprint

Venous Thromboembolism
Hospital Emergency Service
Hospitalization
Urban Hospitals
Thromboembolism
Teaching Hospitals
Observational Studies
Psychiatry
Renal Dialysis
Length of Stay
Prospective Studies
Guidelines
Physicians

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

Cite this

Levine, R. L., Hergenroeder, G. W., Miller, C. C., & Davies, A. (2007). Venous thromboembolism prophylaxis in emergency department admissions. Journal of Hospital Medicine, 2(2), 79-85. https://doi.org/10.1002/jhm.171

Venous thromboembolism prophylaxis in emergency department admissions. / Levine, Robert L.; Hergenroeder, Georgene W.; Miller, Charles C.; Davies, Al.

In: Journal of Hospital Medicine, Vol. 2, No. 2, 01.03.2007, p. 79-85.

Research output: Contribution to journalArticle

Levine, RL, Hergenroeder, GW, Miller, CC & Davies, A 2007, 'Venous thromboembolism prophylaxis in emergency department admissions', Journal of Hospital Medicine, vol. 2, no. 2, pp. 79-85. https://doi.org/10.1002/jhm.171
Levine, Robert L. ; Hergenroeder, Georgene W. ; Miller, Charles C. ; Davies, Al. / Venous thromboembolism prophylaxis in emergency department admissions. In: Journal of Hospital Medicine. 2007 ; Vol. 2, No. 2. pp. 79-85.
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abstract = "Background: Guidelines for venous thromboembolism prophylaxis exist, yet prophylaxis is underutilized and inadequately studied in the context of emergency department admissions. Objective: This study aimed to measure the rate of venous thromboembolism prophylaxis in emergency department hospitalizations. Design: Prospective observational study. Setting: Urban, teaching hospital. Patients: Adult emergency department admissions. Intervention: Alternating admissions through the emergency department over 1 month were reviewed. Exclusion criteria were: requiring full anticoagulation, hemodialysis, length of stay less than 2 days, psychiatric admission, and primary physician declined review. An established risk assessment tool classified thromboembolism risk. Appropriate prophylaxis was defined as currently accepted medical or mechanical prophylaxis if in need or no prophylaxis if not indicated. Measurements: Factors associated with prophylaxis were considered significant if P < .05. Results: Of 254 patients, 201 (79{\%}) had indications for prophylaxis, of whom 65 (32{\%}) received it. Seventy-eight percent of prophylaxis orders were written in the first day of hospitalization. Factors related to increased use of prophylaxis included use of standard order sets (OR = 3, P < .009) and increased risk of venous thromboembolism (P < .0001). Factors related to underuse included primary cardiovascular diagnosis (OR = 0.18, P < .0001) and age (OR = 0.97, P < .0001). Eighteen of 26 patients admitted for whom standard order sets were used (69{\%}) received appropriate prophylaxis (P = .01). Conclusions: Patients admitted through the emergency department are at high risk of venous thromboembolism. Despite this, venous thromboembolism prophylaxis is underutilized and rarely started after the first day of hospitalization. Use of admission standard order sets on admission from the emergency department may increase thromboembolic prophylaxis.",
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AB - Background: Guidelines for venous thromboembolism prophylaxis exist, yet prophylaxis is underutilized and inadequately studied in the context of emergency department admissions. Objective: This study aimed to measure the rate of venous thromboembolism prophylaxis in emergency department hospitalizations. Design: Prospective observational study. Setting: Urban, teaching hospital. Patients: Adult emergency department admissions. Intervention: Alternating admissions through the emergency department over 1 month were reviewed. Exclusion criteria were: requiring full anticoagulation, hemodialysis, length of stay less than 2 days, psychiatric admission, and primary physician declined review. An established risk assessment tool classified thromboembolism risk. Appropriate prophylaxis was defined as currently accepted medical or mechanical prophylaxis if in need or no prophylaxis if not indicated. Measurements: Factors associated with prophylaxis were considered significant if P < .05. Results: Of 254 patients, 201 (79%) had indications for prophylaxis, of whom 65 (32%) received it. Seventy-eight percent of prophylaxis orders were written in the first day of hospitalization. Factors related to increased use of prophylaxis included use of standard order sets (OR = 3, P < .009) and increased risk of venous thromboembolism (P < .0001). Factors related to underuse included primary cardiovascular diagnosis (OR = 0.18, P < .0001) and age (OR = 0.97, P < .0001). Eighteen of 26 patients admitted for whom standard order sets were used (69%) received appropriate prophylaxis (P = .01). Conclusions: Patients admitted through the emergency department are at high risk of venous thromboembolism. Despite this, venous thromboembolism prophylaxis is underutilized and rarely started after the first day of hospitalization. Use of admission standard order sets on admission from the emergency department may increase thromboembolic prophylaxis.

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