Venous thromboembolism (VTE), which encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common preventable complication in hospitalized patients. Risk assessment tools allow for easy stratification of patient VTE risk and have been demonstrated to reduce incidence of VTE. However, risk assessment tools remain underutilized in clinical practice. This scoping review aims to explore barriers and facilitators to VTE risk assessment usage to improve rates of hospital-acquired VTE and provide recommendations for future implementation strategies. Four databases (PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews) were searched from January 1990 through December 2025, and 59 studies were included after selection by three independent reviewers. Themes related to ‘decreased provider compliance’ and ‘difficulty of use’ were the most commonly cited barriers. For facilitators, the majority of themes surrounded ‘electronic medical record integration,’ ‘forcing functions,’ and ‘education.’ A prevalence of barriers and a paucity of facilitators contribute to decreased VTE risk assessment usage. Hospital administrators and clinicians should address current barriers and promote facilitators during VTE risk assessment initiatives to maximize patient quality improvement outcomes. (Prospero ID: CRD42022360033)
BraunBIKolbuszKMBozikisMR, et al. Venous thromboembolism performance measurement in the United States: An evolving landscape with many stakeholders. J Hosp Med. 2024; 19: 827–840.
5.
RathbunS.Cardiology patient pages. The Surgeon General’s call to action to prevent deep vein thrombosis and pulmonary embolism. Circulation2009; 119: e480–482.
6.
CohenATTapsonVFBergmannJF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): A multinational cross-sectional study. Lancet2008; 371: 387–394.
7.
GouldMKGarciaDAWrenSM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest2012; 141(2 suppl): e227S–e277S.
8.
PannucciCJSwistunLMacDonaldJK, et al. Individualized venous thromboembolism risk stratification using the 2005 Caprini Score to identify the benefits and harms of chemoprophylaxis in surgical patients: A meta-analysis. Ann Surg2017; 265: 1094–1103.
9.
GeertsWHBergqvistDPineoGF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest2008; 133(6 suppl): 381S–453S.
10.
MooteMEnglesbeMBahlV, et al. PA-driven VTE risk assessment improves compliance with recommended prophylaxis. JAAPA2010; 23: 27–30, 32–35.
11.
LamBDDodgeLEDattaS, et al. Venous thromboembolism prophylaxis for hospitalized adult patients: A survey of US health care providers on attitudes and practices. Res Pract Thromb Haemost2023; 7: 102168.
12.
ProctorESilmereHRaghavanR, et al. Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health2011; 38: 65–76.
13.
EijgenraamPMeertensNvan den HamR, et al. The effect of clinical decision support on adherence to thrombosis prophylaxis guidelines in medical patients; A single center experience. Thromb Res2015; 135: 464–471.
14.
SooGCWong DooNCBurrowsJ, et al. Improving the adoption of an electronic clinical decision support tool and evaluating its effect on venous thromboembolism prophylaxis prescribing at a Sydney tertiary teaching hospital. J Pharm Pract Res2019; 49: 508–516.
15.
ParkMYFletcherJPHoffmannC, et al. Prevention of venous thromboembolism through the implementation of a risk assessment tool: A comparative study in medical and surgical patients. Int Angiol2018; 37: 411–418.
16.
BrockbankKSnoxallSBeaumontA, et al. Implementing a venous thromboembolism (VTE) prevention strategy. Clin Gov Int J2010; 15: 19–28.
17.
DurieuxPNizardRRavaudP, et al. A clinical decision support system for prevention of venous thromboembolism: Effect on physician behavior. JAMA2000; 283: 2816–2821.
18.
NwuluUBrooksHRichardsonS, et al. Electronic risk assessment for venous thromboembolism: Investigating physicians’ rationale for bypassing clinical decision support recommendations. BMJ Open2014; 4: e005647.
19.
PaiMLloydNSChengJ, et al. Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): A pilot cluster randomized trial. Implement Sci2013; 8: 1.
20.
SykesPKWalshKDarceyCM, et al. Prevention of venous thromboembolism amongst patients in an acute tertiary referral teaching public hospital: A best practice implementation project. Int J Evid Based Healthc2016; 14: 64–73.
21.
PrestonHSwanIDaviesL, et al. Improving VTE risk assessment and prophylaxis prescribing rate in medical patients: Integrating risk assessment tool into the workflow. BMJ Open Qual2020; 9: e000903.
22.
CassidyMRRosenkranzPMcAnenyD.Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program. J Am Coll Surg2014; 218: 1095–1104.
23.
PrescottLSKidinLMDownsRL, et al. Improved compliance with venous thromboembolism pharmacologic prophylaxis for patients with gynecologic malignancies hospitalized for nonsurgical indications did not reduce venous thromboembolism incidence. Int J Gynecol Cancer2015; 25: 152–159.
24.
NendazMRChopardPLovisC, et al. Adequacy of venous thromboprophylaxis in acutely ill medical patients (IMPART): Multisite comparison of different clinical decision support systems. J Thromb Haemost2010; 8: 1230–1234.
25.
RastogiRLattimoreCMMehaffeyJH, et al. Electronic health record risk-stratification tool reduces venous thromboembolism events in surgical patients. Surg Open Sci2022; 9: 34–40.
26.
VyasDBearellyDBoshardB.A multidisciplinary quality improvement educational initiative to improve the rate of deep-vein thrombosis prophylaxis. Int J Pharm Pract2014; 22: 92–95.
27.
KhouryLDangodaraAALeeJA, et al. Implementation of a mandated venous thromboembolism clinical order set improves venous thromboembolism core measures. Hosp Pract (1995)2014; 42: 89–99.
28.
McCarthyMJByrneGSilvermanSH.The setting up and implementation of a venous thromboembolism prophylaxis policy in clinical hospital practice. J Eval Clin Pract1998; 4: 113–117.
29.
QinXYuPLiH, et al. Integrating the “best” evidence into nursing of venous thromboembolism in ICU patients using the i-PARIHS framework. PloS One2020; 15: e0237342.
30.
WuJZhuSMunnZZhouC.Improving compliance of risk assessment and nonpharmacological interventions for deep venous thrombosis prevention in a respiratory ICU: A best practice implementation project. JBI Evid Implement2020; 19: 268–278.
31.
BerkinJALeeCLandsbergerE, et al. Scorecard implementation improves identification of postpartum patients at risk for venous thromboembolism. J Healthc Risk Manag2016; 36: 8–13.
32.
ShlebakASandhuPAliV, et al. The impact of the DoH Commissioning for quality and innovation incentive on the success of venous thromboembolism risk assessment in hospitalised patients. A single institution experience in a quality outcome improvement over a 4-year cycle. JRSM Open2016; 7: 2054270416632702.
33.
StarkJEBirdMLSmithWJ, et al. Multidisciplinary approach to improve venous thromboembolism risk assessment and prophylaxis rates in hospitalized patients. J Pharm Technol2012; 28: 171–178.
34.
DuffJWalkerKOmariA.Translating venous thromboembolism (VTE) prevention evidence into practice: A multidisciplinary evidence implementation project. Worldviews Evid Based Nurs2011; 8: 30–39.
35.
BoddiMCecchiABonizzoliM, et al. Follow-up after four-year quality improvement program to prevent inferior limb deep vein thrombosis in intensive care unit. Thromb Res2014; 134: 578–583.
36.
WattBJWilliamsDTLewisLWhitakerCJ.Thromboprophylaxis prescribing among junior doctors: The impact of educational interventions. BMC Health Serv Res2016; 16: 267.
37.
LeCuyerMNymanVSykesFThomasK.Reducing venous thromboembolism risk through a collaborative team approach. J Perianesthesia Nurs2021; 36: 452–459.
38.
GeorgeBDCookTAFranklinIJ, et al. Protocol violation in deep vein thrombosis prophylaxis. Ann R Coll Surg Engl1998; 80: 55–57.
39.
MossSRMartinezKANathanC, et al. Physicians’ views on utilization of an electronic health record-embedded calculator to assess risk for venous thromboembolism among medical inpatients: A qualitative study. TH Open2022; 6: e33–e39.
40.
TitiMAAlotairHAFayedA, et al. Effects of computerised clinical decision support on adherence to VTE prophylaxis clinical practice guidelines among hospitalised patients. Int J Qual Health Care2021; 33: mzab034.
41.
BauerJBChunDSKarpinskiTA.Pharmacist-led program to improve venous thromboembolism prophylaxis in a community hospital. Am J Health Syst Pharm2008; 65: 1643–1647.
42.
LecumberriRMarquésMDíaz-NavarlazMT, et al. Maintained effectiveness of an electronic alert system to prevent venous thromboembolism among hospitalized patients. Thromb Haemost2008; 100: 689–704.
43.
KucherNKooSQuirozR, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med2005; 352: 969–977.
44.
TahaHGovindrajEJaberF, et al. Improving venous thromboembolism prophylaxis through critical thinking and health informatics. BMJ Open Qual2020; 9: e000885.
45.
JaspersTDuisenberg-van EssenbergMMaatB, et al. A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines. Int J Clin Pharm2021; 43: 1327–1336.
46.
California Acute Stroke Pilot Registry Investigators. The impact of standardized stroke orders on adherence to best practices. Neurology2005; 65: 360–365.
47.
StelfoxHTBrundin-MatherRSooA, et al. A multicentre controlled pre-post trial of an implementation science intervention to improve venous thromboembolism prophylaxis in critically ill patients. Intensive Care Med2019; 45: 211–222.
48.
LuYChenFYCaiL, et al. Early warning prevention and control strategies to reduce perioperative venous thromboembolism in patients with gastrointestinal cancer. World J Clin Cases2022; 10: 3035–3046.
49.
ChongJCurtainCGadF, et al. Development and implementation of venous thromboembolism stewardship across a hospital network. Int J Med Inform2021; 155: 104575.
50.
BaseyAJKrskaJKennedyTDMackridgeAJ.Challenges in implementing government-directed VTE guidance for medical patients: A mixed methods study. BMJ Open2012; 2: e001668.
51.
HorstmanMJCowartJBMcmaster-BaxterNL, et al. A human factors approach to improving electronic performance measurement of venous thromboembolism prophylaxis. Int J Qual Health Care2016; 28: 59–65.
52.
RobertsLNPorterGBarkerRD, et al. Comprehensive VTE prevention program incorporating mandatory risk assessment reduces the incidence of hospital-associated thrombosis. Chest2013; 144: 1276–1281.
53.
LiFWalkerKMcInnesEDuffJ.Testing the effect of a targeted intervention on nurses’ compliance with “best practice” mechanical venous thromboembolism prevention. J Vasc Nurs2010; 28: 92–96.
54.
ShapiroSDunniganAKeenSClarkeP.Interventional bundle for venous thromboembolism prevention: Ensuring quality and effectiveness. BMJ Open Qual2019; 8: e000459.
55.
NanaMShuteCWilliamsR, et al. Multidisciplinary, patient-centred approach to improving compliance with venous thromboembolism (VTE) prophylaxis in a district general hospital. BMJ Open Qual2020; 9: e000680.
56.
PetersonGMDrakeCIJupeDM, et al. Educational campaign to improve the prevention of postoperative venous thromboembolism. J Clin Pharm Ther1999; 24: 279–287.
57.
GastonSWhiteS.Venous thromboembolism (VTE) risk assessment: Rural nurses’ knowledge and use in a rural acute care hospital. Int J Nurs Pract2013; 19: 60–64.
58.
GallagherMOliverKHurwitzM.Improving the use of venous thromboembolism prophylaxis in an Australian teaching hospital. BMJ Qual Saf2009; 18: 408–412.
59.
BagotCGohilSPerrottR, et al. The use of an exclusion-based risk-assessment model for venous thrombosis improves uptake of appropriate thromboprophylaxis in hospitalized medical patients. QJM2010; 103: 597–605.
60.
KrimskyWSMrozIBMcIlwaineJK, et al. A model for increasing patient safety in the intensive care unit: Increasing the implementation rates of proven safety measures. Qual Saf Health Care2009; 18: 74–80.
Diana YapFSNgZYWongCY, et al. Appropriateness of deep vein thrombosis (DVT) prophylaxis use among medical inpatients: A DVT risk alert tool (DRAT) study. Med J Malaysia2019; 74: 45–50.
63.
BeutelBGJenkinsLS.Preventing venous thromboembolism at a district hospital: A quality improvement study. S Afr Fam Pract2015; 57: 64–68.
64.
LesterWFreemantleNBegajI, et al. Fatal venous thromboembolism associated with hospital admission: A cohort study to assess the impact of a national risk assessment target. Heart2013; 99: 1734–1739.
65.
DahmkeHFiumefreddoRSchuetzP, et al. Tackling alert fatigue with a semi-automated clinical decision support system: Quantitative evaluation and end-user survey. Swiss Med Wkly2023; 153: 40082.
66.
MartinKALyleroehrMJCameronKA.Barriers and facilitators to preventing venous thromboembolism in oncology practice. Thromb Res2022; 220: 21–23.
67.
AbboudJShaikhNMoosaM, et al. Increasing venous thromboembolism risk assessment through a whole hospital-based intervention: A pre-post service evaluation to demonstrate quality improvement. Int J Qual Health Care2024; 36: mzae019.
68.
Naji IsaidEJoudehAIShereefN, et al. Enhancing venous thromboembolism prophylaxis compliance: A quality initiative for standardised risk assessment in a hospital setting. BMJ Open Qual2025; 14: e003239.
69.
HanMHuangJYangJ, et al. Barriers and facilitators to the implementation of guidelines for venous thromboembolism prevention and management: A mixed-methods systematic review. Int J Nurs Stud Adv2024; 8: 100273.
70.
PetersenLAWoodardLDUrechT, et al. Does pay-for-performance improve the quality of health care?Ann Intern Med2006; 145: 265–272.
71.
JaganjacBHansenKWLundeHHunnesJA.The role of organizational culture and structure in implementing sustainability initiatives. Business Ethics, the Environment & Responsibility2025; 34: 1239–1254.
72.
ParkHRibièreVSchulteWDJr.Critical attributes of organizational culture that promote knowledge management technology implementation success. J Knowl Manag2004; 8: 106–117.
73.
LockwoodRKableAHunterS.Evaluation of a nurse-led intervention to improve adherence to recommended guidelines for prevention of venous thromboembolism for hip and knee arthroplasty patients: A quasi-experimental study. J Clin Nurs2018; 27: e1048–e1060.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
