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首页> 外文期刊>Implementation Science >Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial
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Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial

机译：加强住院医疗患者静脉血栓预防的策略（SENTRY）：一项试验性随机分组试验

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Background Venous thromboembolism (VTE) is a common preventable cause of mortality in hospitalized medical patients. Despite rigorous randomized trials generating strong recommendations for anticoagulant use to prevent VTE, nearly 40% of medical patients receive inappropriate thromboprophylaxis. Knowledge-translation strategies are needed to bridge this gap. Methods We conducted a 16-week pilot cluster randomized controlled trial (RCT) to determine the proportion of medical patients that were appropriately managed for thromboprophylaxis (according to the American College of Chest Physician guidelines) within 24 hours of admission, through the use of a multicomponent knowledge-translation intervention. Our primary goal was to determine the feasibility of conducting this study on a larger scale. The intervention comprised clinician education, a paper-based VTE risk assessment algorithm, printed physicians’ orders, and audit and feedback sessions. Medical wards at six hospitals (representing clusters) in Ontario, Canada were included; three were randomized to the multicomponent intervention and three to usual care (i.e., no active strategies for thromboprophylaxis in place). Blinding was not used. Results A total of 2,611 patients (1,154 in the intervention and 1,457 in the control group) were eligible and included in the analysis. This multicomponent intervention did not lead to a significant difference in appropriate VTE prophylaxis rates between intervention and control hospitals (appropriate management rate odds ratio = 0.80; 95% confidence interval: 0.50, 1.28; p = 0.36; intra-class correlation coefficient: 0.022), and thus was not considered feasible. Major barriers to effective knowledge translation were poor attendance by clinical staff at education and feedback sessions, difficulty locating preprinted orders, and lack of involvement by clinical and administrative leaders. We identified several factors that may increase uptake of a VTE prophylaxis strategy, including local champions, support from clinical and administrative leaders, mandatory use, and a simple, clinically relevant risk assessment tool. Conclusions Hospitals allocated to our multicomponent intervention did not have a higher rate of medical inpatients appropriately managed for thromboprophylaxis than did hospitals that were not allocated to this strategy.
机译：背景技术静脉血栓栓塞症（VTE）是住院医疗患者常见的可预防死亡原因。尽管进行了严格的随机试验，强烈建议使用抗凝剂预防VTE，但仍有近40％的内科患者接受了不适当的血栓预防。需要知识翻译策略来弥合这一差距。方法我们进行了一项为期16周的试验性整群随机对照试验（RCT），以确定入院后24小时内通过合理使用血栓预防措施（根据美国胸科医师协会的指导方针）进行适当血栓预防治疗的医学患者比例。多成分知识翻译干预。我们的主要目标是确定进行大规模研究的可行性。干预措施包括临床医生教育，基于纸张的VTE风险评估算法，印刷医生的医嘱以及审核和反馈会议。其中包括加拿大安大略省的六家医院（代表医院群）的医疗病房; 3例被随机分配到多成分干预措施，而3例被随机分配到常规护理（即没有适当的血栓预防主动策略）。未使用致盲。结果共有2611例患者（干预组1154例，对照组1457例）符合条件并纳入分析。这种多成分干预并未导致干预医院与对照医院的适当VTE预防率有显着差异（适当的管理率比值比= 0.80; 95％的置信区间：0.50、1.28; p = 0.36;组内相关系数：0.022） ，因此被认为不可行。有效知识翻译的主要障碍包括临床工作人员参加教育和反馈会议的出席率低，难以找到预印本的订单以及临床和行政领导缺乏参与。我们确定了可能增加采用VTE预防策略的几个因素，包括当地拥护者，临床和行政领导的支持，强制使用以及简单的，与临床相关的风险评估工具。结论分配给我们的多因素干预措施的医院没有适当分配血栓预防措施的医疗住院患者比没有分配给该策略的医院具有更高的比率。

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