B. D. Lau1,3, M. B. Streiff2, D. B. Hobson1, P. S. Kraus4, D. L. Shaffer1, V. O. Popoola1, D. T. Efron1, E. R. Haut1 1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Medicine,Baltimore, MD, USA 3Johns Hopkins University School Of Medicine,Health Sciences Informatics,Baltimore, MD, USA 4Johns Hopkins University School Of Medicine,Pharmacy,Baltimore, MD, USA
Introduction: Venous thromboembolism (VTE) prevention is one of the most frequent targets for patient safety and quality improvement in hospitals. In 2013, we began providing individualized feedback to general surgery residents about their VTE prophylaxis prescribing habits which has improved VTE prevention on the general surgery services. We hypothesized that this feedback would also improve VTE prophylaxis prescription by the same residents during non-general surgery rotations. The purpose of this study was to investigate the indirect, or ‘halo,’ effect of providing individualized feedback to residents regarding prescription of appropriate VTE prophylaxis.
Methods: This retrospective cohort study compared appropriate VTE prophylaxis prescription for all patients admitted to the adult trauma service from July 1, 2012 – May 31, 2015 at a Level 1 trauma center. On October 1, 2013, we began providing monthly feedback to general surgery residents regarding their VTE prophylaxis prescribing habits while on general surgery rotations. Data were not provided about off-service practice nor to any other prescribers within the hospital. We compared performance of surgery residents rotating on the adult trauma service before and after they began receiving individualized feedback. We also compared the performance of general surgery residents to all other prescribers (e.g. non-categorical interns, rotating residents, nurse practitioners) who wrote VTE prophylaxis orders on the adult trauma service during the study period.
Results: During the study period, 931 patients were admitted to the adult trauma service and assessed using the trauma-specific risk assessment tool. During the 15-month pre-feedback period, surgery residents wrote appropriate VTE prophylaxis orders for 78.5% trauma patients and other prescribers wrote appropriate orders for 75.4% patients, p=0.441. Surgery residents’ ordering practice for trauma patients significantly improved during the 20-month post-feedback period (94.5% vs 78.5%, p<0.001). Practice significantly improved among other prescribers during the post-feedback period, as well (84.3% vs 75.4%, p=0.036); however, practice was significantly better among surgery residents compared with other prescribers (94.5% vs 84.3%, p=0.001).
Conclusion: Individualized resident feedback has been shown to directly improve VTE prescribing practice. We found a beneficial ‘halo’ effect for other patients treated by those residents. There is a secondary, albeit smaller, ‘halo’ effect for patients treated by prescribers who may be aware of the feedback project despite not directly receiving feedback. Individualized feedback regarding practice habits should be implemented for all providers.
