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Open Access Research article

Educational outreach visits to improve venous thromboembolism prevention in hospitalised medical patients: a prospective before-and-after intervention study

Jed Duff123*, Abdullah Omari1, Sandy Middleton24, Elizabeth McInnes24 and Kim Walker13

Author Affiliations

1 St Vincent’s Private Hospital Sydney, Victoria Street, 2010, Darlinghurst, NSW, Australia

2 National Centre for Clinical Outcomes Research, Australian Catholic University, Sydney, Australia

3 University of Tasmania School of Nursing & Midwifery, Education Centre, 1 Leichhardt St, 2010, Darlinghurst, NSW, Australia

4 Nursing Research Institute, St Vincent’s & Mater Health Sydney- Australian Catholic University, St Vincent’s Hospital, Victoria Street, 2010, Darlinghurst, NSW, Australia

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BMC Health Services Research 2013, 13:398  doi:10.1186/1472-6963-13-398

Published: 8 October 2013

Abstract

Background

Despite the availability of evidence-based guidelines on venous thromboembolism (VTE) prevention clinical audit and research reveals that hospitalised medical patients frequently receive suboptimal prophylaxis. The aim of this study was to evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV) on the provision of VTE prophylaxis to hospitalised medical patients in a 270 bed acute care private hospital in metropolitan Australia.

Methods

The study used an uncontrolled before-and-after design with accompanying process evaluation. The acceptability of the intervention to participants was measured with a post intervention survey; descriptive data on resource use was collected as a measure of utility; and clinical impact (prophylaxis rate) was assessed by pre and post intervention clinical audits. Doctors who admit >40 medical patients each year were targeted to receive the intervention which consisted of a one-to-one educational visit on VTE prevention from a trained peer facilitator. The EOV protocol was designed by a multidisciplinary group of healthcare professionals using social marketing theory.

Results

Nineteen (73%) of 26 eligible participants received an EOV. The majority (n = 16, 85%) felt the EOV was effective or extremely effective at increasing their knowledge about VTE prophylaxis and 15 (78%) gave a verbal commitment to provide evidence-based prophylaxis. The average length of each visit was 15 minutes (IQ range 15 to 20) and the average time spent arranging and conducting each visit was 92 minutes (IQ range 78 to 129). There was a significant improvement in the proportion of medical patients receiving appropriate pharmacological VTE prophylaxis following the intervention (54% to 70%, 16% improvement, 95% CI 5 to 26, p = 0.004).

Conclusions

EOV is effective at improving doctors’ provision of pharmacological VTE prophylaxis to hospitalised medical patients. It was also found to be an acceptable implementation strategy by the majority of participants; however, it was resource intensive requiring on average 92 minutes per visit.

Keywords:
Educational outreach visit; Implementation science; Venous thromboembolism prevention