Summary

Impact of an emergency department nurse training intervention on the adequacy of thromboprophylaxis for venous thromboembolism: the PROTESU III study

César Rincón Díaz1, Sònia Jiménez Hernández2, Fahd Beddar Chaib3,4, Laura Lozano Polo5, Leticia Guirado Torrecillas6, María Cortés Ayaso7, Ana Isabel Condon Abanto8, Jorge Pedraza García9, Gema Muñoz Gamito10, David Jiménez11-13, Ramón Lecumberri14,15, Pedro Ruiz Artacho1,13,16, en representación del Grupo de Trabajo de Enfermedad Tromboembólica Venosa de la Sociedad Española de Medicina de Urgencias y Emergencias (ETV-SEMES)

Affiliation of the authors

1Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, Spain. 2Área de Urgencias, Hospital Clinic, IDIBAPS, Barcelona, Spain. 3Servicio de Urgencias, Complejo Asistencial de Soria, Spain. 4Universidad de Valladolid, Facultad de Ciencias de la Salud, Valladolid, Spain. 5Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 6Servicio de Medicina Interna, Hospital Universitario Virgen La Arrixaca, Murcia, Spain. 7Servicio de Urgencias, Hospital Clínico Universitario de Santiago, A Coruña, Spain. 8Servicio de Urgencias, Hospital Universitario Joan XXIII, Tarragona, Spain. 9Servicio de Urgencias, Hospital Valle de los Pedroches, Córdoba, Spain. 10Area de Calidad y Seguridad Paciente. Fundació Assistencial Mutua Terrassa, Barcelona, Spain. 11Servicio de Neumología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain. 12Departamento de Medicina, Universidad de Alcalá (IRYCIS), Madrid, Spain. 13CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain. 14Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. 15CIBER-CV, Madrid, Spain. 16Interdisciplinar Teragnosis and Radiosomics (INTRA) Research Group, Universidad de Navarra, Spain. En representación del grupo ETV-SEMES.

DOI

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Quote

Rincón Díaz C, Jiménez Hernández S, Beddar Chaib F, Lozano Polo L, Guirado Torrecillas L, Cortés Ayaso M, et al. Impact of an emergency department nurse training intervention on the adequacy of thromboprophylaxis for venous thromboembolism: the PROTESU III study. Emergencias. 2024;36:359-66

Summary

Objectives.

To assess the impact of training for emergency department (ED) nurses on adequate thromboprophylaxis for patients admitted to hospital from the ED for medical conditions.

Methods.

Multicenter quasiexperimental pre-post study of an ED nurse training intervention in 8 hospitals. Patients were recruited from January 2022 through May 2023 in 3 phases: before nurse training, in the first month after training, and in the sixth month after training. Included were patients attended in the ED for medical conditions. Adequate thromboprophylaxis was defined as 1) use of prophylactic drugs in patients at high risk for venousthromboembolism according to the Padua Prediction Score (PPS), and 2) nonuse in patients at low risk. We compared the percentage of adequate prophylaxis in the first phase to the percentages in the second and third phases.

Results.

A total of 928 patients were included (326 in phase 1, 295 in phase 2, and 307 in phase 3). PPS scores indicated that 238 (73%) of the patients were at high risk in phase 1 vs 189 (64.1%, P = .016) in phase 2 and 207 (67.4%, P = .125) in phase 3. A total of 187 patients (57.4%, 95% CI, 51.8%-62.8%) were adequatelythromboprophylaxed in phase 1 vs 178 (60.%, 95% CI, 54.5%-66%) in phase 2 (absolute
difference in proportions, 3.0% (95% CI, –4.8% to 10.6%; P = .462)]. In phase 3, 166 patients (54.1%, 95% CI, 48.3%-59.7%) received
adequate prophylaxis (difference, –3.3% (95% CI, -11.0% to 4.4%; P = .405).

Conclusions.

A training intervention for ED nurses, implemented as an isolated strategy, had no impact on the adequacy of thromboprophylaxis in patients admitted from the ED for medical conditions.

 

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