Authors (including presenting author) :
Leader: Pong Wing Tung Members: Tang Chung Yan, Chan Oi Ling, Kwok Yen Yi
Affiliation :
Department of Orthopaedics & Traumatology, Tseung Kwan O Hospital
Keyword 1: :
Venous thromboembolism, VTE
Keyword 2: :
Evidence based practice, EBP
Keyword 3: :
screening tools
Introduction :
Venous thromboembolism (VTE) remains a prevalent and preventable complication in hospitalized patients, with orthopaedic inpatients facing particularly high risk due to surgery, immobility, and trauma, evidenced by 31 VTE cases reported in the O&T department in Tseung Kwan O Hospital (TKOH) from Jan 2020 to Dec 2024. Currently, the TKOH Orthopaedic & Traumatology (O&T) Department lacks standardized screening and interventions, relying on non-standardized clinical judgment and variable physician preferences, which contributes to inconsistent prophylaxis, increased mortality, prolonged stays, and misalignment with CHIHA accreditation standards. This critical quality-safety gap makes the evidence-based practice (EBP) project essential, systematically transitioning to a consistent, evidence-based risk assessment protocol via the Johns Hopkins Evidence-Based Practice (JHEBP) Model.
Objectives :
Guided by the JHEBP Model's Practice Question, Evidence, and Translation phases, the objectives were to: 1) Identify validated VTE risk assessment tools applicable to orthopaedic inpatients. 2) Select the most suitable tool for TKOH O&T through evidence synthesis and appraisal. (3) Develop organization-specific implementation recommendations considering fit, feasibility, and acceptability.
Methodology :
2025 Johns Hopkins Evidence-Based Practice Model was used, beginning with a structured PICO question: “Among adult patients admitted to the orthopaedic unit (P), what are the evidence-based clinical scoring tools for VTE risk assessment (I), compared with the current non-standardised VTE screening and prophylactic interventions (C ) that are shown to reduce the incidence of hospital-acquired VTE(O)?” Targeted searches of Ovid MEDLINE, CINAHL Plus, and Embase (2015–2025) identified 899 full-text english literature, with 40 studies selected for synthesis on orthopaedic and trauma populations. Tools such as Caprini RAM, STTGMA, Wells, Padua, Autar, and TESS were rigorously appraised using JHEBP evidence summary, synthesis, and translation tools to assess validity, VTE impact, feasibility, and contextual fit.
Result & Outcome :
Caprini RAM (Risk assessment model) was identified and recommended as the optimal tool with moderate-to-reasonable certainty evidence for stratifying VTE risk and guiding prophylaxis in orthopaedic patients, outperforming STTGMA (strong for prognosis but lacking VTE-specific intervention links). This study provides an evidence-based foundation to inform the management team for later phase Caprini implementation. Foreseeably reducing hospital-acquired VTE incidence, enhancing patient safety, and aligning with CHIHA standards, paving the way for quality improvements across TKOH.
