Murray Robert, Brauner Jordan, Welty Mike, Gauntt Jennifer, Treinen Charles, Muszynski Jennifer A, Cloyd Colleen, Rodriguez Vilmarie
Division of Critical Care, Nationwide Children's Hospital, Columbus, OH.
Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OH.
Pediatr Crit Care Med. 2025 Aug 7. doi: 10.1097/PCC.0000000000003809.
We aimed to reduce the rate of hospital-acquired venous thromboembolism (HA-VTE) in the PICU by 50% from 2.07 to 1.04 venous thromboembolism (VTE) per 1000 patient days by June 2023 and sustain this change for 6 months.
Prospective quality improvement project.
The PICU of an urban academic free-standing children's hospital in the United States.
All patients admitted to the PICU between December 2020 and December 2023.
We identified key drivers including: provider knowledge gaps surrounding VTE risk in our patient population, identification of patients at risk of VTE, the absence of appropriate screening and prevention tools, and central venous line duration and location. These key drivers were each addressed with the most significant intervention being the creation of a simple screening tool to identify and provide thromboprophylaxis recommendations for patients most at risk for developing VTE.
We identified the monthly occurrence rate of VTE as our outcome measure, the provision of VTE thromboprophylaxis as our process measure and the presence of bleeding events as our balancing measure. The rate of VTE in PICU patients decreased from 2.07 to 1.14 per 1000 patient days. There was an increase in the provision of pharmacologic thromboprophylaxis during our intervention period from 36% to 42% with no change in the rate of mechanical thromboprophylaxis. There were only two instances of clinically relevant non-major bleeding as defined by the International Society of Thrombosis and Haemostasis definition in nonsurgical patients on anti-hemostatic agents during our intervention period. There was a decrease in central venous catheter days from 43% to 31% of PICU patient days during the intervention period.
Upon implementing a protocolized screening and prevention tool for VTE, we observed a decreased occurrence of HA-VTE.
我们的目标是到2023年6月，将儿科重症监护病房（PICU）中医院获得性静脉血栓栓塞症（HA-VTE）的发生率从每1000个患者日2.07例静脉血栓栓塞症（VTE）降低50%至1.04例，并将这一变化维持6个月。
前瞻性质量改进项目。
美国一家城市学术性独立儿童医院的PICU。
2020年12月至2023年12月期间入住PICU的所有患者。
我们确定了关键驱动因素，包括：医护人员对我们患者群体中VTE风险的认知差距、VTE风险患者的识别、缺乏适当的筛查和预防工具，以及中心静脉置管的持续时间和位置。针对这些关键驱动因素分别采取了相应措施，其中最重要的干预措施是创建一个简单的筛查工具，以识别最易发生VTE的患者并提供血栓预防建议。
我们将VTE的月发生率作为结局指标，VTE血栓预防措施的提供情况作为过程指标，出血事件的发生情况作为平衡指标。PICU患者的VTE发生率从每1000个患者日2.07例降至1.14例。在我们的干预期内，药物性血栓预防措施的提供率从36%增至42%，而机械性血栓预防措施的比率没有变化。在我们的干预期内，接受抗止血药物治疗的非手术患者中，按照国际血栓与止血学会的定义，仅出现两例临床相关的非大出血情况。在干预期内，中心静脉导管使用天数占PICU患者日数的比例从43%降至31%。
在实施针对VTE的标准化筛查和预防工具后，我们观察到HA-VTE的发生率有所下降。
