A Collaborative Multidisciplinary Trauma Program Improvement Team Improves VTE Chemoprophylaxis Guideline Compliance In Non-Operative Stable TBI. J Trauma Acute Care Surg 2024 Mar 04
Date
03/04/2024Pubmed ID
38437527DOI
10.1097/TA.0000000000004294Abstract
BACKGROUND: Delays in initiating venous thromboembolism (VTE) prophylaxis in patients suffering from traumatic brain injury (TBI) persist despite guidelines recommending early initiation. We hypothesized that the expansion of a Trauma Program Performance Improvement (PI) team will improve compliance of early (24-48 hour) initiation of VTE prophylaxis and will decrease VTE events in TBI patients.
METHODS: We performed a single-center retrospective review of all TBI patients admitted to a Level I trauma center before (2015-2016,) and after (2019-2020,) the expansion of the Trauma Performance Improvement and Patient Safety (PIPS) team and the creation of trauma process and outcome dashboards. Exclusion criteria included discharge or death within 48 hours of admission, expanding intracranial hemorrhage on CT scan, and a neurosurgical intervention (craniotomy, pressure monitor, or drains) prior to chemoprophylaxis initiation.
RESULTS: A total of 1,112 patients met the inclusion criteria, of which 54% (n = 604) were admitted after Trauma PIPS expansion. Following the addition of a dedicated PIPS nurse in the trauma program and creation of process dashboards, the time from stable CT to VTE prophylaxis initiation decreased (52 hours to 35 hours; p < 0.001) and more patients received chemoprophylaxis at 24-48 hours (59% from 36%, p < 0.001) after stable head CT. There was no significant difference in time from first head CT to stable CT (9 vs 9 hours; p = 0.15). The Contemporary group had a lower rate of VTE events (1% vs 4%; p < 0.001) with no increase in bleeding events (2% vs 2%; p = 0.97). On multivariable analysis, being in the Early cohort was an independent predictor of VTE events (aOR: 3.74; 95%CI: 1.45-6.16).
CONCLUSION: A collaborative multidisciplinary Trauma PIPS team improves guideline compliance. Initiation of VTE chemoprophylaxis within 24-48 hours of stable head CT is safe and effective.
LEVEL OF EVIDENCE: Level III, Therapeutic/Care Management.
Author List
Al Tannir AH, Golestani S, Tentis M, Maring M, Biesboer EA, Dodgion C, Murphy PB, Holena DN, Trevino CM, Peschman JR, Carver TW, Milia DJ, Schellenberg M, de Moya MA, Morris RSAuthors
Abdul Hafiz Al Tannir MD Postdoctoral Fellow in the Surgery department at Medical College of WisconsinThomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin
Daniel N. Holena MD Professor in the Surgery department at Medical College of Wisconsin
Jacob R. Peschman MD Assistant Professor in the Surgery department at Medical College of Wisconsin
