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Scorecard implementation improves identification of postpartum patients at risk for venous thromboembolism
Author(s) -
Berkin Jill A.,
Lee Colleen,
Landsberger Ellen,
Chazotte Cynthia,
Bernstein Peter S.,
Goffman Dena
Publication year - 2016
Publication title -
journal of healthcare risk management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.221
H-Index - 16
eISSN - 2040-0861
pISSN - 1074-4797
DOI - 10.1002/jhrm.21229
Subject(s) - medicine , balanced scorecard , confidence interval , odds ratio , population , chemoprophylaxis , body mass index , emergency medicine , intensive care medicine , environmental health , management , economics
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.