Authors: (including presenting author): :
Chan VYL, Chao CYL, Lam CPY, Wong SCM, O HHH, Ip SYW, Leung CYY
Affiliation: :
Physiotherapy Department, Princess Margaret Hospital
Keyword 1: :
venous thromboembolism (VTE)
Keyword 2: :
deep vein thrombosis (DVT)
Keyword 3: :
pulmonary embolism
Keyword 5: :
physiotherapy
Introduction: :
Hospital-acquired venous thromboembolism (VTE) refers to both deep vein thrombosis (DVT) or pulmonary embolism (PE) event that happens within 90 days of hospitalization. It is associated with significant health complications and death. Evidences suggest that 70% of hospital-acquired VTE cases are preventable and physiotherapy plays a crucial role for risk identification and management via non-pharmacological means like providing mechanical thromboprophylaxis such as graduated compression elastic stocking and promoting early mobilization and ambulation. Using standardized risk assessment tools to assess thromboembolic risk aids to stratifying risk and planning care while regular audits are crucial for ensuring adherence to VTE prevention guideline and consistent use of thromboprophylaxis.
Objectives: :
To improve staff knowledge and compliance on VTE screening using standardized tools and provision of physiotherapeutic thromboprophylaxis according to the stratified VTE risk for enhancing safety and quality of care for hospitalized patients.
Methodology: :
Quality improvement initiatives were established and implemented in the physiotherapy department of Princess Margaret Hospital. These include (i) standardizing VTE screening and risk assessment tools using 3 different types of pre-printed stickers (VTE common signs and symptoms checklist, Wells’ criteria for suspected DVT cases, revised Geneva criteria (Simplified version) for suspected PE cases, (ii) establishing in-house workflow and protocols on VTE risk stratification into low, moderate and high and the suggested thromboprophylaxis measures, (iii) provision of cue cards, (iv) providing staff training, knowledge testing and feedback collection, (v) implementing the practices to all specialties at in-patient units, (vi) conducting audit on adherences to VTE prevention guideline and in-house workflow/ protocol, and (vii) debriefing on audit results.
Result & Outcome: :
Seventy-five physiotherapists attended one-hour training on VTE prevention and risk-stratified physiotherapy management strategies, and 73 completed the post-training quiz on knowledge testing via google form. Only 29 of them answered correctly for all the questions. The average knowledge score was 78.8±20.7 out of 100. The questions with most incorrect responses were identified for further follow-up and explanation. Greater than 95% of the respondents expressed strongly agree or agree that the course contents were relevant to their work and the speakers has enhanced their learning and understanding on the topic with appropriate training duration and format. All physiotherapists received cue cards on in-house workflow and protocol on VTE risk-stratified management strategy and feedbacked it was useful. For the auditing on adherences to VTE prevention guideline and in-house workflow/ protocol, 30 in-patient cases from acute orthopedic, general surgical and medical specialty were randomly selected for auditing in September 2025 at PMH. The corresponding compliance rate to the 8-item audited criteria was 100%, 97.8% and 97.2% respectively. Routine VTE screening using standardized tools, followed by risk-stratified thromboprophylaxis measures to hospitalized patients is a best practice to decrease its occurrence and improve patient safety. This requires staff knowledge and ongoing training, and when regular audits are integrated in the process to ensure adherence to suggested guideline and protocols for enhancing quality care and patient outcomes.
