Appropriate Use of Sequential Compression Devices: A High Value Based Care Initiative

From the 2019 HVPAA National Conference

Dr. Preston Kerr (University of Texas Medical Branch), Dr. Tamer Dafashy (University of Texas Medical Branch), Mr. Ali Mohammad (University of Texas Medical Branch), Dr. En Shuo Hsu (University of Texas Medical Branch), Ms. Hattie Faddis (University of Texas Medical Branch), Mr. Elias Farran (University of Texas Medical Branch), Mrs. Paula Townley (University of Texas Medical Branch), Dr. Gulshan Sharma (University of Texas Medical Branch), Dr. Stephen Williams (University of Texas Medical Branch)

Background

Sequential compression devices (SCDs) are routinely used for venous thromboembolism (VTE) prophylaxis. Current guidelines recommend SCD use in specific orthopedic populations or when bleeding risks prohibit pharmacologic prophylaxis.

Objectives

We sought to define utilization patterns and potential quality of care predictors regarding SCD use at our institution, and decrease the rates of inappropriate SCD usage.

Methods

A quality initiative driven intervention took place from December 1, 2017 to June 31, 2018. We randomly sampled patients admitted to a single university hospital across three separate days prior to intervention from December 1, 2017 to January 31, 2018. An intervention during the month of February 2018 was implemented. This consisted of nursing and hospital leadership education, as well as a change in the hospital policy regarding SCD use. After intervention, hospital patients were again sampled across three separate days from June 1, 2018 to June 31, 2018. Patients in the emergency department, pediatric units, and obstetrics units were excluded from our sampling. Data extraction included chart abstraction combined with direct patient observation. Continuous characteristics were tested with an independent t-test. Categorical characteristics were tested using Chi-square analysis.

Results

A total of 989 patients of 1,159 (85.3%) were sampled over six days. Prior to intervention a total of 437 of 607 (71.0%) admitted patients were randomly sampled over three separate days. At 4 months post intervention, 552 (100%) admitted patients were sampled over 3 separate days. A total of 248 (56.8%), 83 (19.0%), and 106 (24.3%) patients were sampled across medical, surgical, and intensive care units, respectively. A total of 329 (59.6%), 114 (20.6%), and 109 (19.7%) were sampled from the same units post intervention. Compared prior to intervention, we observed a significant increase in appropriate use of SCDs following intervention across all units (46.2% vs. 77.1%, p<0.001)Appropriate use of SCDs in medical, intensive care, and surgical units, respectively, were 53.2% (N=132), 22.9% (N=19), and 48,1% (N=51) compared to 79.0% (N=260), 64.9% (N=74), and 84.4% (N=92; for all values P <0.0001) post intervention.

Conclusions

At four months post-intervention we have documented an significant increase in appropriate use of SCDs across all units in the hospital where our intervention was applied.

Clinical Implications

The results of this study represent a successful intervention initiative within our hospital system to improve the appropriate utilization of SCDs in the prevention of VTEs using cost-effective measures. This represents our initial attempt to create a standardized framework to appropriately use mechanical prophylaxis in the prevention of VTEs. This will help us deliver high quality evidence based care without compromising outcomes or value.