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Cited by 53Venous Thromboembolism Diagnosis and ManagementInnovations in Medical EducationClinical Reasoning and Diagnostic Skills

Individualized Performance Feedback to Surgical Residents Improves Appropriate Venous Thromboembolism Prophylaxis Prescription and Reduces Potentially Preventable VTE: A Prospective Cohort Study

Lau, Brandyn D., Arnaoutakis, George J., Streiff, Michael B., Howley, Isaac W., Poruk, Katherine E., Beaulieu, Robert, Ellison, Trevor A., Van Arendonk, Kyle J. +6 more·2016·Annals of Surgery
DOI 10.1097/sla.0000000000001512
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Abstract

OBJECTIVE: To investigate the effect of providing personal clinical effectiveness performance feedback to general surgery residents regarding prescription of appropriate venous thromboembolism (VTE) prophylaxis. BACKGROUND: Residents are frequently charged with prescribing medications for patients, including VTE prophylaxis, but rarely receive individual performance feedback regarding these practice habits. METHODS: This prospective cohort study at the Johns Hopkins Hospital compared outcomes across 3 study periods: (1) baseline, (2) scorecard alone, and (3) scorecard plus coaching. All general surgery residents (n = 49) and surgical patients (n = 2420) for whom residents wrote admission orders during the first 9 months of the 2013-2014 academic year were included. Outcomes included the proportions of patients prescribed appropriate VTE prophylaxis, patients with preventable VTE, and residents prescribing appropriate VTE prophylaxis for every patient, and results from the Accreditation Council for Graduate Medical Education resident survey. RESULTS: At baseline, 89.4% of patients were prescribed appropriate VTE prophylaxis and only 45% of residents prescribed appropriate prophylaxis for every patient. During the scorecard period, appropriate VTE prophylaxis prescription significantly increased to 95.4% (P < 0.001). For the scorecard plus coaching period, significantly more residents prescribed appropriate prophylaxis for every patient (78% vs 45%, P = 0.0017). Preventable VTE was eliminated in both intervention periods (0% vs 0.35%, P = 0.046). After providing feedback, significantly more residents reported receiving data about practice habits on the Accreditation Council for Graduate Medical Education resident survey (87% vs 38%, P < 0.001). CONCLUSIONS: Providing personal clinical effectiveness feedback including data and peer-to-peer coaching improves resident performance, and results in a significant reduction in harm for patients.

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Authors
Lau, B. D., Arnaoutakis, G. J., Streiff, M. B., Howley, I. W., Poruk, K. E., Beaulieu, R., Ellison, T. A., Van Arendonk, K. J., Kraus, P. S., Hobson, D. B., Holzmueller, C. G., Black, J. H., Pronovost, P. J., & Haut, E. R.
Affiliations
Johns Hopkins University (US)
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-12
Volume
264
Issue
6
Pages
1181-1187
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/sla.0000000000001512
OpenAlex
W2318386729
Cited by
53
References
39
Citations by year
2026: 3 · 2025: 3 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 7 · 2019: 4 · 2018: 10 · 2017: 8 · 2016: 9
FWCI
9.17
Type
journal article
Language
en
Open access
closed
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords
thromboprophylaxis, surgical residents, performance feedback, scorecard, drug prescribing, general surgery residency, resident survey, quality improvement
MeSH terms
Adult, Clinical Competence, Education, Medical, Graduate, Feedback, Female, Humans, Internship and Residency, Male, Peer Group, Prospective Studies, General Surgery, Baltimore, Venous Thromboembolism

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