Scorecard implementation improves identification of postpartum patients at risk for venous thromboembolism

Jill A. Berkin, Colleen Lee, Ellen Landsberger, Cynthia Chazotte, Peter S. Bernstein, Dena Goffman

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To evaluate if an intensive educational intervention in the use of a standardized venous thromboembolism (VTE) risk assessment tool (scorecard) improves physicians' identification and chemoprophylaxis of postpartum patients at risk for VTE.

METHODS: After implementation of a VTE scorecard and prior to an intensive educational intervention, postpartum patients (n = 140) were evaluated to assess scorecard completion, risk factors, and chemoprophylaxis. A performance improvement campaign focusing on patient safety, VTE prevention, and scorecard utilization was then conducted. Evaluation of the same parameters was subsequently performed for a similar group of patients (n = 133). Differences in scorecard utilization and risk assessment were tested for statistical significance.

RESULTS: Population-at-risk rates were similar in both assessment periods (31.4% vs 28.6%; p = NS). The greatest risk factors included cesarean delivery, body mass index (BMI) >30 and age >35. Scorecard completion rates for all patients increased in the postintervention period (15.7% vs 67.7%; p < .001). Postintervention scorecard completion rates for the at-risk population also improved (20% vs 79%; p < .001). In the postintervention group, those at risk with completed scorecards had higher prophylaxis rates than those at risk without scorecards (73% vs 25%; p = .03). At-risk patients with completed scorecards had 2.6 times more orders for chemoprophylaxis than at-risk patients without scorecards in both time periods (odds ratio [OR] = 8.4; 95% confidence interval [CI] 3.1-22.8).

CONCLUSION: Utilization of a VTE scorecard coupled with an educational intervention for health care providers increases detection and chemoprophylaxis orders for at-risk patients. Encouraging universal scorecard assessment standardizes identification and chemoprophylaxis of at-risk patients who were otherwise not perceived to be at risk.

Original languageEnglish (US)
Pages (from-to)8-13
Number of pages6
JournalJournal of healthcare risk management : the journal of the American Society for Healthcare Risk Management
Volume36
Issue number1
DOIs
StatePublished - Jul 1 2016

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Venous Thromboembolism
Postpartum Period
Chemoprevention
Patient Safety
Health Personnel
Body Mass Index
Odds Ratio
Confidence Intervals
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Scorecard implementation improves identification of postpartum patients at risk for venous thromboembolism. / Berkin, Jill A.; Lee, Colleen; Landsberger, Ellen; Chazotte, Cynthia; Bernstein, Peter S.; Goffman, Dena.

In: Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management, Vol. 36, No. 1, 01.07.2016, p. 8-13.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To evaluate if an intensive educational intervention in the use of a standardized venous thromboembolism (VTE) risk assessment tool (scorecard) improves physicians' identification and chemoprophylaxis of postpartum patients at risk for VTE.METHODS: After implementation of a VTE scorecard and prior to an intensive educational intervention, postpartum patients (n = 140) were evaluated to assess scorecard completion, risk factors, and chemoprophylaxis. A performance improvement campaign focusing on patient safety, VTE prevention, and scorecard utilization was then conducted. Evaluation of the same parameters was subsequently performed for a similar group of patients (n = 133). Differences in scorecard utilization and risk assessment were tested for statistical significance.RESULTS: Population-at-risk rates were similar in both assessment periods (31.4{\%} vs 28.6{\%}; p = NS). The greatest risk factors included cesarean delivery, body mass index (BMI) >30 and age >35. Scorecard completion rates for all patients increased in the postintervention period (15.7{\%} vs 67.7{\%}; p < .001). Postintervention scorecard completion rates for the at-risk population also improved (20{\%} vs 79{\%}; p < .001). In the postintervention group, those at risk with completed scorecards had higher prophylaxis rates than those at risk without scorecards (73{\%} vs 25{\%}; p = .03). At-risk patients with completed scorecards had 2.6 times more orders for chemoprophylaxis than at-risk patients without scorecards in both time periods (odds ratio [OR] = 8.4; 95{\%} confidence interval [CI] 3.1-22.8).CONCLUSION: Utilization of a VTE scorecard coupled with an educational intervention for health care providers increases detection and chemoprophylaxis orders for at-risk patients. Encouraging universal scorecard assessment standardizes identification and chemoprophylaxis of at-risk patients who were otherwise not perceived to be at risk.",
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