Effectiveness of an artificial intelligence clinical assistant decision support system to improve the incidence of hospital-associated venous thromboembolism: a prospective, randomised controlled study

BACKGROUND

Thromboprophylaxis has been determined to be safe, effective and cost-effective for hospitalised patients at venous thromboembolism (VTE) risk. However, Chinese medical institutions have not yet fully used or improperly used thromboprophylaxis. The effectiveness of information technology applied to thromboprophylaxis in hospitalised patients has been proved in many retrospective studies, lacking of prospective research evidence.

METHODS

All hospitalised patients aged >18 years not discharged within 24 hours from 1 September 2020 to 31 May 2021 were prospectively enrolled. Patients were randomly assigned to the control (9890 patients) or intervention group (9895 patients). The control group implemented conventional VTE prevention programmes; the intervention group implemented an Artificial Intelligence Clinical Assistant Decision Support System (AI-CDSS) on the basis of conventional prevention. Intergroup demographics, disease status, hospital length of stay (LOS), VTE risk assessment and VTE prophylaxis were compared using the χ2 test, Fisher's exact test, t-test or Wilcoxon rank-sum test. Univariate and multivariate logistic regressions were used to explore the risk factor of VTE.

RESULTS

The control and intervention groups had similar baseline characteristics. The mean age was 58.32±15.41 years, and mean LOS was 7.82±7.07 days. In total, 5027 (25.40%) and 2707 (13.67%) patients were assessed as having intermediate-to-high VTE risk and high bleeding risk, respectively. The incidence of hospital-associated VTE (HA-VTE) was 0.38%, of which 86.84% had deep vein thrombosis. Compared with the control group, the incidence of HA-VTE decreased by 46.00%, mechanical prophylaxis rate increased by 24.00% and intensity of drug use increased by 9.72% in the intervention group. However, AI-CDSS use did not increase the number of clinical diagnostic tests, prophylaxis rate or appropriate prophylaxis rate.

CONCLUSIONS

Thromboprophylaxis is inadequate in hospitalised patients with VTE risk. The role of AI-CDSS in VTE risk management is unknown and needs further in-depth study.

TRIAL REGISTRATION NUMBER

ChiCTR2000035452.

Compliance of non-pharmacological preventive practice of venous thromboembolism among Jordanian nurses

Many practices, such as non-pharmacological preventive practices, have demonstrated significant improvement and reduced the venous thromboembolism incidence. This study aims at investigating the compliance with non-pharmacological preventive practice of venous thromboembolism guidelines among Jordanian intensive care and medical and surgical nurses. Descriptive and cross-sectional with the non-participant observational design was used. This study recruited 271 registered nurses in adult medical-surgical units and intensive care units of 12 different government hospitals in Jordan's middle and north regions. The observational checklist included 10 preventive practices based on the non-pharmacological preventive of venous thromboembolism guidelines. In the observational checklist, the highest score was 20, and the lowest was 0. If the nurse received equal to or higher than (>14) score were classified as sufficient compliance, while insufficient compliance was (≤14) score. The observations period started from September 2019 until March 2020. The participants' overall mean venous thromboembolism compliance score was insufficient compliance (10.6 ± 1.6). The majority of nurses were classified as insufficient compliance 67%. "Doing foot exercise and early ambulation 2 times per day 50.3%" and "checked the integrity of the patient's skin at regular intervals 50.0%" were the highest practices done rightly and completely by half of the participants. The participants who had a bachelor of nursing degree, staff nurse, and works in the intensive care unit, are less experienced and have no previous venous thromboembolism education reported low venous thromboembolism compliance. This study presents expanded compliance regarding venous thromboembolism preventive practices among Jordanian intensive care and medical & surgical nurses, so the policymakers need to develop an initiative to improve nurses' compliance.

Impact of Medicare's Nonpayment Program on Venous Thromboembolism Following Hip and Knee Replacements

OBJECTIVE

To determine whether Medicare's Nonpayment Program was associated with decline in venous thromboembolism (VTE) following hip and knee replacements; and whether the decline was greater among hospitals at risk of larger financial losses from the Program.

DATA SOURCES

State Inpatient Database for New York (NY) from 2005 to 2013.

STUDY DESIGN

The primary outcome was an occurrence of VTE. Medicare Utilization Ratio (MUR), which is the proportion of inpatient days in a hospital that is financed by Medicare, represented a hospital's financial sensitivity. We used hierarchical logistic regressions with difference-in-differences estimation to study the Program effects.

PRINCIPAL FINDINGS

A total of 98,729 hip replacement and 111,361 knee replacement stays were identified. For hip replacement, the Program was associated with significant reduction (Range: 44% to 53%) in VTE incidence among hospitals in MUR quartiles 2 to 4. For knee replacement, the Program was associated with significant reduction (47%) in VTE incidence only among quartile 2 hospitals.

CONCLUSION

Implementation of the Program was associated with a reduction in VTE, especially for hip replacements, in higher MUR hospitals. Payment reforms such as Medicare's Nonpayment Program that withhold payments for complications are effective and should be continued.

Clinical factors associated with inappropriate prophylaxis of venous thromboembolic disease in critically ill patients. A single day cross-sectional study

PURPOSE

A poor implementation of VTE prophylactic measures recommended for critically ill patients has been observed in several epidemiological studies. The clinical factors associated with this have not been clearly established. The objective of our study was to identify which factors could be related to the inappropriate use of VTE prophylaxis.

METHODS

Analytic epidemiological study based on different aspects of VTE prophylaxis performed on Spanish ICU patients. A multiple logistic regression analysis was conducted to identify the risk factors associated with inappropriate prophylaxis, according to the American College of Chest Physicians 2012 guidelines.

RESULTS

We enrolled 777 patients. On admission, 62% presented medical, 30% surgical and 8% major trauma pathology. Of all patients, 41% were receiving an inappropriate prophylaxis, including 19% which did not receive any prophylaxis. The presence of a contraindication for pharmacological prophylaxis (OR 3.91, 95% CI 2.50-6.10) and non-medical pathology at ICU admission (OR 11.09; 95% CI 7.63-16.12) were associated with inappropriate prophylaxis. In contrast, mechanical ventilation (OR 0.70, 95% CI 0.45-0.98), bed rest>48h (OR 0.61, 95% CI 0.49-0.98), the use of a protocol for VTE prophylaxis (OR 0.66, 95% CI 0.45-0.98) and a VTE risk scoring system (OR 0.49, 95% CI 0.24-0.98) were associated with adequate prophylaxis.

CONCLUSIONS

Our study highlighted a poor compliance with the VTE prophylaxis recommendations proposed for critical patients. The implementation of specific protocols for prophylaxis that include a correct evaluation according to VTE and haemorrhage risk, would allow for optimisation of mechanical and combined prophylaxis, improving adherence to the clinical practice guidelines.