This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (66)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Thrombolysis  • Venous Thromboembolism  • Alert me on articles by topic

Physician Practices in the Community Hospital Setting

Dale W. Bratzler, DO, MPH; Gary E. Raskob, MSc; Cynthia K. Murray, PhD; Lisa J. Bumpus, RN; Donna S. Piatt, RN

Arch Intern Med. 1998;158:1909-1912.

Background  Venous thromboembolism is a common complication of surgery. Although surveys of physician self-reported practices have suggested near universal support for routine use of measures to prevent venous thromboembolism, medical record auditing has demonstrated underuse.

Objective  To assess physician practices of venous thromboembolism prophylaxis in the community hospital setting.

Methods  Retrospective review of the medical records from 20 hospitals in Oklahoma of 419 Medicare patients aged 65 years or older undergoing major abdominothoracic surgery between April 1 and December 31, 1995. Utilization rates of prophylaxis stratified according to patient risk for venous thromboembolism were measured.

Results  Prophylaxis measures were implemented for only 160 (38%) of 419 patients studied (95% confidence interval, 33%-43%). There was little variation in the use of prophylaxis based on the risk for venous thromboembolism. Only 97 (39%) of 250 patients (95% confidence interval, 33%-45%) at very high risk received any form of prophylaxis and of these 97, only 64 patients (66%) received appropriate measures (95% confidence interval, 56%-75%).

Conclusions  Despite widely disseminated, evidence-based recommendations, venous thromboembolism prophylaxis is underused in Medicare patients undergoing major abdominothoracic surgery in community hospitals in Oklahoma.

From the Oklahoma Foundation for Medical Quality Inc (Drs Bratzler and Murray and Mss Bumpus and Piatt), the Clinical Epidemiology Unit, Veterans Administration Medical Center, and the Departments of Biostatistics and Epidemiology and Medicine, University of Oklahoma Health Sciences Center (Mr Raskob), Oklahoma City.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Acute Pulmonary Embolism
Tapson
NEJM 2008;358:1037-1052.
FULL TEXT  

Hospitals' compliance with prophylaxis guidelines for venous thromboembolism
Yu et al.
Am J Health Syst Pharm 2007;64:69-76.
ABSTRACT | FULL TEXT  

A Pharmacist-Initiated Method to Improve Venous Thromboembolic Prophylaxis Rates in Medically Ill Patients
Stark and Vesta
Journal of Pharmacy Practice 2006;19:275-279.
ABSTRACT  

Venous thromboembolism: application and effectiveness of the american college of chest physicians 2001 guidelines for prophylaxis.
Steier et al.
JAOA: Journal of the American Osteopathic Association 2006;106:388-395.
ABSTRACT | FULL TEXT  

Patient ethnicity and use of venous thromboembolism prophylaxis
Gelber and Seto
Int J Qual Health Care 2006;18:23-29.
ABSTRACT | FULL TEXT  

The Effect of a Computerized Reminder System on the Prevention of Postoperative Venous Thromboembolism
Mosen et al.
Chest 2004;125:1635-1641.
ABSTRACT | FULL TEXT  

Relationship Between Deep Venous Thrombosis and the Postthrombotic Syndrome
Kahn and Ginsberg
Arch Intern Med 2004;164:17-26.
ABSTRACT | FULL TEXT  

Venous Thromboembolic Prophylaxis in Hospitalized Medical Patients
Stark and Kilzer
The Annals of Pharmacotherapy 2004;38:36-40.
ABSTRACT | FULL TEXT  

Comment: venous thromboembolism prophylaxis conversion in nonsurgical inpatients
Fanikos and Tsilimingras
The Annals of Pharmacotherapy 2003;37:1914-1915.
FULL TEXT  

Venous Thromboembolism Prophylaxis Conversion in Nonsurgical Inpatients
Carroll and Hudson
The Annals of Pharmacotherapy 2003;37:1194-1196.
ABSTRACT | FULL TEXT  

The Potential Role of Direct Thrombin Inhibitors in the Prevention and Treatment of Venous Thromboembolism
Heit
Chest 2003;124:40S-48S.
ABSTRACT | FULL TEXT  

The Potential Role of Fondaparinux as Venous Thromboembolism Prophylaxis After Total Hip or Knee Replacement or Hip Fracture Surgery
Heit
Arch Intern Med 2002;162:1806-1808.
FULL TEXT  

Relative Impact of Risk Factors for Deep Vein Thrombosis and Pulmonary Embolism: A Population-Based Study
Heit et al.
Arch Intern Med 2002;162:1245-1248.
ABSTRACT | FULL TEXT  

Missed Opportunities for Prevention of Venous Thromboembolism : An Evaluation of the Use of Thromboprophylaxis Guidelines
Arnold et al.
Chest 2001;120:1964-1971.
ABSTRACT | FULL TEXT  

Prevention of Venous Thromboembolism
Geerts et al.
Chest 2001;119:132S-175S.
FULL TEXT