T. S. Dharmarajan, MD
In January 2007, Internal Medicine residents at Montefiore North began formalized training to assess and prevent deep vein thrombosis (DVT) in all Department of Medicine hospitalized patients. A standardized order form identifying criteria for risk assessment and options for prophylaxis was added to newly admitted patients’ charts, and a new resident elective was implemented to monitor performance improvement (PI) in which data were collected weekly by trainees not participating in direct assessments at admission.
As of January 2009, nearly 11,000 hospitalized patients had been monitored for DVT risk. Throughout the 2-year period, the percentage of patients identified to be at risk for DVT and given appropriate preventive treatment increased significantly, suggesting that repetitive formal education, monitoring and supervision of trainees improved compliance with DVT risk assessment and prophylaxis; a standardized form in each patient’s chart provided for easy implementation of monitoring, and having senior trainees (chief residents and fellows) gather the data impressed trainees of its importance.
The DVT project won second prize at the 2009 Bronx City Society meeting, and was accepted for presentation at the 2009 American College of Physicians New York Chapter meeting.
Specialized resident training and assessment for DVT risk at admission continues. In the next step, now underway, investigators are collecting follow-up data on patients assessed to be at risk for DVT to track reassessment efforts for anticoagulation use, patient outcomes, and adverse events.