Audit of venous thromboembolic prophylaxis in emergency general surgical admissions

Abstract

Objective: The aim was to audit venous thromboembolic disease (VTE) prophylaxis in emergency surgical admissions and, given the reducing number of available surgical beds, to compare protocol violation rates between surgical and outlying wards.

Method: Study 1: Prospective data collected on VTE prophylaxis in emergency surgical patients over a two-week period during or after the post-take ward round. Provisional diagnoses were recorded and drug charts were reviewed looking for prescription of standard unfractionated heparin 5000 IU and/or thromboembolic deterrent stockings. Following presentation at the governance meeting, departmental protocols were circulated to the emergency surgical unit and outlying wards that received emergency surgical patients. Study 2: Carried out two months later. Data on VTE prophylaxis collected over a two-week period in emergency surgical admissions in the same manner as study 1.

Results: Study 1: A total of 70 patients were studied, 42 of which were women. The median age of the group was 47 years (range 19–90). There were 36 patients (51.2%) who violated VTE prophylaxis protocol. Of the 60 patients admitted to surgical wards, 29 violated VTE protocol (48.3%). Of the 10 patients admitted to outlying wards, seven violated VTE protocol (70%). This difference was not statistically significant. Study 2: A total of 70 patients were studied, 40 of which were women. The median age was 46 years (range 17–101). Eleven patients (15.7%) violated VTE prophylaxis recommendations. This improvement was statistically significant, P<0.0001. Some 56 patients were admitted to general surgical wards; nine violated VTE protocol (16.1%). In the fourteen patients admitted to outlying wards, there were two protocol violations (14.3%). This difference was not statistically significant.

Conclusions: VTE is a potentially fatal complication of hospital admission. This audit highlighted that VTE prophylaxis rates in our emergency admissions were unacceptable at 51.2%, but were improved through audit and clinical governance. No significant difference in protocol violation was found between surgical and outlying wards. In the absence of national guidelines, VTE prophylaxis is the responsibility of individual general surgical departments and requires a documented, circulated departmental protocol, education of staff and regular audit to ensure appropriate compliance.