Venous thromboembolism prophylaxis in emergency department admissions

BACKGROUND: Guidelines for venous thromboembolism prophylaxis exist, yet prophylaxis is underutilized and inadequately studied in the context of emergency department admissions. OBJECTIVE: This study aimed to measure the rate of venous thromboembolism prophylaxis in emergency department hospitalizations. DESIGN: Prospective observational study. SETTING: Urban, teaching hospital. PATIENTS: Adult emergency department admissions INTERVENTION: Alternating admissions through the emergency department over I month were reviewed. Exclusion criteria were: requiring full anticoagulation, hemodialysis, length of stay less than 2 days, psychiatric admission, and primary physician declined review. An established risk assessment tool classified thromboembolism risk. Appropriate prophylaxis was defined as currently accepted medical or mechanical prophylaxis if in need or no prophylaxis if not indicated. MEASUREMENTS: Factors associated with prophylaxis were considered significant if P <.05. RESULTS: Of 254 patients, 201 (79%) had indications for prophylaxis, of whom 65 (32%) received it. Seventy-eight percent of prophylaxis orders were written in the first day of hospitalization. Factors related to increased use of prophylaxis included use of standard order sets (OR = 3, P <.009) and increased risk of venous thromboembolism (P <.0001). Factors related to underuse included primary cardiovascular diagnosis (OR = 0.18, P <.0001) and age (OR = 0.97, P <.0001). Eighteen of 26 patients admitted for whom standard order sets were used (69%) received appropriate prophylaxis (P = .01). CONCLUSIONS: Patients admitted through the emergency department are at high risk of venous thromboembolism. Despite this, venous thromboembolism prophylaxis is underutilized and rarely started after the first day of hospitalization. Use of admission standard order sets on admission from the emergency department may increase thromboembolic prophylaxis. Journal of Hospital Medicine 2007;2: 79-85. (c) 2007 Society of Hospital Medicine.