IMPROVING COMPLIANCE WITH VTE RISK ASSESSMENT AND THROMBOPROPHYLAXIS IN GENERAL SURGICAL PATIENTS A CLINICAL AUDIT AND PDSA-BASED QUALITY IMPROVEMENT PROJECT

Abstract

Background: Venous thromboembolism (VTE) remains an important preventable complication in surgical patients. Effective prevention depends on timely assessment of VTE and bleeding risk followed by appropriate pharmacological and/or mechanical thromboprophylaxis. Despite the availability of established recommendations, these practices may not be consistently incorporated into routine surgical care. This clinical audit and PDSA based quality-improvement project was undertaken to assess compliance with recommended VTE prevention practices and to improve them through a structured PDSA-based intervention.
Aim: To assess and improve compliance with VTE risk assessment and appropriate thromboprophylaxis among general surgical patients in Surgical C Unit, Ayub Teaching Hospital, Abbottabad.
Methods: A clinical audit and quality-improvement project was conducted using a prospective before-and-after audit design with a PDSA cycle. The project was carried out in Surgical C Unit of Ayub Teaching Hospital, Abbottabad. The baseline audit was conducted from 1 March 2022 to 10 May 2022, followed by an intervention phase from 10 May to 31 May 2022 and a post-intervention re-audit from 10 June to 20 August 2022. Adult patients admitted for general surgical management were assessed against predefined VTE prevention standards based on established clinical recommendations. The audit evaluated documentation of VTE risk assessment, bleeding-risk assessment, appropriateness of pharmacological thromboprophylaxis, documentation of reasons for withholding prophylaxis, and use of mechanical prophylaxis where indicated. The intervention included staff education, reinforcement of VTE and bleeding-risk assessment, standardised documentation/checklist use, visual reminders, and feedback regarding baseline performance. The same audit standards and data-collection approach were used during the re-audit. Categorical variables were analysed using the chi-square test or Fisher's exact test, as appropriate.
Results: A total of 230 eligible patients were included, comprising 112 patients in the baseline audit and 118 patients in the post-intervention re-audit. Documentation of VTE risk assessment increased from 48.2% (54/112) at baseline to 77.1% (91/118) after the intervention (p<0.001). Documented bleeding-risk assessment increased from 54.5% (61/112) to 71.2% (84/118) (p=0.007). Among patients for whom pharmacological Thromboprophylaxis was indicated, appropriate prophylaxis increased from 48.9% (43/88) to 79.6% (74/93) (p<0.001). Documentation of an appropriate reason for withholding pharmacological prophylaxis increased from 62.5% (15/24) to 88.0% (22/25) (p=0.048). Appropriate mechanical prophylaxis among patients in whom it was indicated increased from 58.1% (18/31) to 83.3% (30/36) (p=0.017). Overall compliance with the predefined VTE prevention standard improved from 43.8% (49/112) at baseline to 72.9% (86/118) following the intervention (p<0.001), representing an absolute improvement of 29.1 percentage points.

Conclusion: This clinical audit identified important gaps in VTE risk assessment, documentation, and thromboprophylaxis practices among general surgical patients at Ayub Teaching Hospital. A targeted PDSA-based intervention incorporating education, standardised documentation, reminders, and feedback was associated with substantial improvement across the major audited VTE prevention processes. The findings demonstrate that a structured and locally feasible quality-improvement approach can improve compliance with recommended VTE prevention practices in a tertiary-care surgical unit. Further periodic audit and re-audit will be required to determine whether these improvements are sustained over time. As the project assessed process measures rather than clinical VTE events, the observed improvement should not be interpreted as evidence of a reduction in DVT or pulmonary embolism.