Abstract Details

Title A Quality Improvement Project to improve the Standardization of Hospital-wide Initiation of chemical VTE Prophylaxis in ICH Patients

Topic Neuro Trauma and Critical Care

Presentation(s) P6 - Poster Session 6 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-004

Background Prevention of venous thromboembolism (VTE) including deep venous thrombosis (DVT) is a mainstay of medical management in intra-cerebral hemorrhage (ICH) patients. The American Heart Association/American Stroke Association recommend after documentation of cessation of bleeding, low-dose subcutaneous low-molecular-weight heparin or unfractionated heparin be initiated after one to four days of onset. Our objective was to increase the use of chemical VTE prophylaxis in ICH patients through education to greater than 60%.

Objective Improving standardization of hospital wide initiation of chemical VTE prophylaxis in ICH patients.

Design/Methods Study patients were selected by medical record query of non-traumatic ICH from June 2020-February 2021 (Pre-education), and from March-September 2021 (Post-education). A standardized protocol was developed by an interdisciplinary team from neurology and neurosurgery. Verbal and written education was distributed across departments: neurology, neurosurgery, and internal medicine. Chart review was performed to include patients either started on chemical VTE prophylaxis or not started on chemical VTE prophylaxis but had hospital stay greater than four days.

Results In the pre-education group, 10 out of 74 (13.51%) was initiated within one-to-four-day time window after documentation of cessation of bleeding. In comparison, 13 out of 52 patients (25%) in the post-education group were initiated within the one-to-four-day time window. Overall, 51.92% of patients with ICH (n=27) were given chemical prophylaxis during admission. Implementation of standardized protocol in ICH patients increased the initiation of VTE prophylaxis by 4-fold.

Conclusions The most frequent reason for not starting chemical VTE prophylaxis was concern of worsening hemorrhage. Although initial goal of >60% was not achieved, standardized protocol and education yielded a significant improvement in chemical VTE prophylaxis rate. The cost of this performance improvement was close to zero dollars and yielded significant improvement in patient care. We aim to increase the rate of chemical VTE prophylaxis in ICH patients to >80% by the end of 2021.

Authors/Disclosures
Sang Han, MD (University of South Alabama) PRESENTER	Dr. Han has nothing to disclose.
Vi Tran, MD (USA University Hospital)	Dr. Tran has nothing to disclose.
Zachary T. Lazzari, MD (Emory University Hospital)	Dr. Lazzari has nothing to disclose.
Peter Soh, MD	Dr. Soh has nothing to disclose.
William A. Kilgo, MD	Dr. Kilgo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Kilgo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Kilgo has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Kilgo has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen.
Rebecca L. Sugg, MD, FAAN (The University of South Alabama Medical Center)	Dr. Sugg has nothing to disclose.