Faculty Collaboration Database

A collaborative multidisciplinary trauma program improvement team improves VTE chemoprophylaxis guideline compliance in non-operative stable TBI. J Trauma Acute Care Surg 2024 Jul 01;97(1):119-124

Date

03/04/2024

Pubmed ID

38437527

DOI

10.1097/TA.0000000000004294

Scopus ID

2-s2.0-85197254442 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

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 hours) 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 hours to 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 (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-6.16).

CONCLUSION: A collaborative multidisciplinary Trauma PIPS team improves guideline compliance. Initiation of VTE chemoprophylaxis within 24 hours to 48 hours of stable head CT is safe and effective.

LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

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 RS

Authors

Thomas W. Carver MD Professor in the Surgery department at Medical College of Wisconsin
Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin
David J. Milia MD Professor in the Surgery department at Medical College of Wisconsin
Rachel S. Morris MD Associate Professor in the Surgery department at Medical College of Wisconsin
Jacob R. Peschman MD Associate Professor in the Surgery department at Medical College of Wisconsin
Colleen Trevino PhD Assoc Professor Clinical Dir Inpatient 2 in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Anticoagulants
Brain Injuries, Traumatic
Female
Guideline Adherence
Humans
Male
Middle Aged
Patient Care Team
Practice Guidelines as Topic
Quality Improvement
Retrospective Studies
Trauma Centers
Venous Thromboembolism