Evaluating the Compliance to 24-Hour Venous Thromboembolism Risk Re-assessment Following Orthopaedic Surgery at a Tertiary Center: A Closed-Loop Clinical Audit

Introduction Venous thromboembolism (VTE) is a preventable cause of patient morbidity and mortality among hospitalised patients. VTE events have a high incidence among orthopaedic patients, who routinely receive chemical thromboprophylaxis in the form of heparin, warfarin, antiplatelet agents or direct oral anticoagulants. These can be associated with adverse events, most commonly bleeding or heparin-induced thrombocytopenia. A VTE risk reassessment following 24 hours of admission or a change in clinical condition like surgery is recommended to avoid such complications. We evaluated the compliance to completion of these reassessments following surgery at a tertiary elective orthopaedic hospital. Methods A closed-loop audit was undertaken for all elective orthoapedic specialties. First loop was conducted between 01/07/2022 and 25/05/2023, whilst the second loop was done between 01/01/2024 and 01/02/2024. Insight, an online database was used to collect data on initial VTE assessment forms completed at admission and VTE reassessment forms completed within 24 hours of surgery, as agreed with orthopaedic teams. Audit standards were derived from National Institute for Health and Care Excellence (NICE) guidelines on venous thromboembolism in over 16s. A target compliance was agreed at 100%. Paediatric patients, day case procedures and medical admissions comprised the exclusion criteria. Results For the first audit loop, only 6/4780 (0.13%) patients had completed VTE reassessment forms within 24 hours following surgery. Following implementation of a system prompt on Electronic Patient Medication Administration (EPMA) to serve as a reminder for VTE reassessment completion, the second audit loop found 112/156 (74%) patients had completed forms (p<0.001). Conclusion VTE risk reassessment following surgery is recommended by NICE guidelines in order to assess and potentially minimize complications like bleeding and heparin-induced thrombocytopenia. A simple intervention such as a system reminder can serve to improve compliance. This can be implemented at a large scale given most hospitals use integrated electronic medication administration systems where initial VTE risk assessments are completed as part of the initial patient admission process.