A Retrospective Longitudinal Study on Venous Thromboembolisms: The Impact of Active Monitoring on the Venous Thromboembolism Management Practices of Healthcare Providers to Improve Patient Outcomes

Abstract

Venous thromboembolism (VTE) is a relatively common condition that is the leading cause of preventable deaths in developed nations. VTE encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) and affects both hospitalized and non-hospitalized patients. When left untreated, VTE is associated with substantial morbidity and mortality; accurate risk assessment and appropriate prophylaxis programs are therefore vital, as overlooked risk factors of these processes can potentially result in misdiagnosis and inappropriate treatment of the condition, with associated complications. In this study, we aimed to assess the impact of active monitoring on VTE management practices among healthcare providers to improve patient outcomes at Imam Abdulrahman Al Faisal Hospital (IAFH) in Riyadh, Saudi Arabia, from April 2018 to July 2023. In this study, a longitudinal retrospective study design was utilized and data from 33,237 admitted patients were analyzed using a Statistical Process Control (SPC) chart to evaluate the relationship between VTE risk assessment, active monitoring, and patient outcomes. In total, 11 cases of hospital-acquired VTE were identified, with patients aged 18–40 years representing most cases (7 out of 11 cases) and a male predominance of 54.5%. The overall VTE incidence rate during the study period was 0.31%, or one case per 11,000 admissions, including four cases of PE and seven cases of DVT. The results of this study indicate that active monitoring through continuous education and regular patient rounds significantly improves adherence to VTE risk assessment and prophylaxis at IAFH. The researchers attributed the increased identification and timely reporting of VTE cases to vigilance by healthcare providers and not to a decline in the quality of care. A comprehensive multidisciplinary strategy for VTE management and continuous quality improvement can aid in reducing VTE-related morbidity and improve patient outcomes. Lastly, we recommend addressing the risk factors associated with the occurrence of hospital-acquired VTE and performing post-discharge follow-ups of patients.

1. Introduction

1.1. Background of the Study

Venous thromboembolism (VTE) is a relatively common condition and the leading cause of preventable deaths in developed countries [1]. VTE refers to both deep vein thrombosis (DVT) and pulmonary embolism (PE), affecting both hospitalized and non-hospitalized patients, with around 100 cases per 100,000 individuals each year [2]. The provided corresponding statistics, stating that an estimated 25,000 people are affected by VTE annually in Saudi Arabia [3].

The primary risk factors for VTE include age, surgery, immobility, hospitalization, cancer, trauma, pregnancy, the postpartum period, hormone use, obesity, and both inherited and acquired conditions that increase blood clotting [4]. That VTE contributes to significant morbidity and mortality, particularly when not properly treated [5]. Once diagnosed, the management of VTE presents significant challenges for healthcare providers. Utilizing the wrong treatment modality or treating the condition in an inappropriate setting can lead to serious complications and, in some cases, life-threatening consequences [4].

Many hospitalized patients do not receive adequate VTE prophylaxis, with 40% and 60% of all VTE cases occurring during or within three months after hospitalization [6]. The hospitalization increases the risk of VTE by about 100 times. VTE can be clinically silent, making proper diagnosis difficult in most hospitalized patients. Researchers and healthcare providers therefore suggest that a systematic approach to VTE prevention, including risk assessments upon hospital admission, can aid in reducing morbidity and mortality [7]. The urge healthcare professionals to follow VTE guidelines closely and call on policymakers to develop an easy-to-use algorithm [1]. Furthermore, the results of previous studies have shown that VTE risk assessment and electronic alerts can enhance prevention efforts and reduce the incidence of hospital-associated thrombosis [8]. In a similar vein, emphasize that accurate risk assessment and personalized pharmacological thromboprophylaxis can aid in reducing the incidence of hospital-acquired VTE [9].

In a study conducted at a hospital in Saudi Arabia, 500 patients were diagnosed with VTE over a period of a year, with a fatality rate of 20.8%. Two-thirds of these patients were on surgical wards, and the remaining third were on medical wards [10]. The authors found that VTE prophylaxis guidelines were poorly implemented and significantly underused. Patients who did not receive VTE prophylaxis were found to have much higher death rates, demonstrating the importance of health authorities ensuring that these guidelines are followed in healthcare settings. In a similar vein, found that while the incidence of VTE is relatively low in hospitalized patients, healthcare providers require further education on VTE assessment and prophylaxis to ensure that they follow relevant guidelines for all patients at admission. Additionally, they state that patient education is vital to ensuring adherence to VTE prevention strategies and recommend performing VTE risk assessments for all patients at discharge to determine if post-discharge prophylaxis is required, which could aid in reducing the risk of VTE following discharge [11].

In their study, ref. [12] discuss the importance of taking all possible measures to prevent VTE in hospitalized patients. Implementing a standardized VTE risk assessment and prophylaxis program aided in reducing rates of hospital-acquired VTE. Together with educational efforts and awareness initiatives, introducing a standardized order set during patient admission, which listed VTE risk factors, also aided in raising awareness about VTE prevention. In a similar vein, ref. [13] reported that, through performance improvement interventions, the hospitals in their study increased compliance with general medicine VTE risk assessment from 4% in April 2014 to 98% in August 2015.

In 2018, the Performance Improvement Project to enhance VTE management was launched at Imam Abdulrahman Al Faisal Hospital, together with the formation of the Venous Thromboembolism Taskforce Committee. The committee aims to perform appropriate assessments of VTE risk in patients and ensure that they receive the proper prophylactic regime according to quality and safety standards. The hospital has implemented policies following CBAHI (Saudi Central Board for Accreditation of Healthcare Institutions) guidelines for VTE and bleeding risk assessments in adult patients and pregnant women. It has also developed specific protocols for groups such as post-natal women, stroke patients, and long-distance travelers, covering treatment modalities such as antithrombotic therapy and pneumatic compression devices.

Although the hospital has evidence-based measures and treatments in place, timely and appropriate VTE prophylaxis delivery is still not adequate. Such gaps can lead to higher readmissions, a greater number of complications, and additional costs. To address these issues, the hospital is exploring solutions that are more effective.

1.2. Aim of the Study

In this study, we aim to assess the impact of active monitoring on VTE management practices among healthcare providers to improve patient outcomes at Imam Abdulrahman Al Faisal Hospital in Riyadh, Saudi Arabia, from April 2018 to July 2023. We also aim to examine the critical role of active monitoring, such as ongoing education and regular ward rounds, in improving adherence to evidence-based guidelines and practice, the accuracy and timeliness of VTE risk assessments, and the provision of prophylaxis. Lastly, we seek to reduce the incidence of hospital-acquired VTE and improve patient outcomes, with the aim of refining and optimizing the entire care process.

1.3. Conceptual Framework

The study is anchored in the Health Belief Model (HBM) developed by [14] which focuses on individuals’ perceptions and behaviors related to health actions and preventive measures. The HBM is one of the most commonly used and applied theories in health behavior, with it suggesting that a person’s health-related actions are influenced by six constructs: the seriousness of a health condition or risk severity, their susceptibility to it, the benefits of taking action, barriers that might prevent action being taken, self-efficacy to take action, and cues that prompt action [15].

In this study, the HBM is used to examine how healthcare providers’ perceptions affect their management of VTE through active monitoring and its subsequent impact on patient outcomes. The HBM can lead to the best behavior changes when messages effectively address perceived barriers, benefits, self-efficacy, and threats. In the case of venous thromboembolism (VTE), risk assessment and prophylaxis, the HBM aids in understanding the beliefs, attitudes, and perceptions of both patients and healthcare providers regarding VTE prevention strategies [16].

However, one of the challenge with the HBM is its assumption that everyone has equal access to health information and services or a similar level of health literacy. Other researchers argue that health knowledge, beliefs, and behavior are closely tied to overall health literacy [17].

Additionally, this model suggests that people are rational and more likely to take health-supporting actions if they believe they can address a health issue, expect effective outcomes, and perceive action feasibility. Effective interventions include how people view the risk of VTE, the challenges or barriers they may face, the benefits of their actions, and their confidence in managing the situation. Patients and healthcare providers must consider the benefits of taking action compared to perceived challenges to improve adherence to VTE prevention guidelines. Consistent training on VTE and health education programs that address these factors can also help promote healthier behaviors for both healthcare providers and patients.

2. Materials and Methods

2.1. Study Design

A retrospective longitudinal study design was used in the present study to identify and track patients over time in order to evaluate the relationship between VTE risk assessment, preventive measures, and patient outcomes. We utilized an existing database that includes records from all (Occurrence Variance Reports) OVRs raised regarding VTE incidents found in all patients’ medical records, root cause analysis of hospital-acquired VTE cases, and all records of patients who developed VTE during hospitalization in IAFH from April 2018 to July 2023, which were reviewed retrospectively. The patients were assessed based on age, sex, length of stay in IAFH, type of VTE acquired, prophylaxis received, and risk factors.

2.2. Study Setting

This study was conducted at Imam Abdulrahman Al Faisal Hospital in Riyadh, Saudi Arabia, to ensure that the research is situated in the healthcare setting where VTE risk assessment and prophylaxis protocols are implemented.

2.3. Study Participants

The inclusion criteria included patients aged >18 admitted to medical, surgical, and gynecological/obstetrical wards between April 2018 and July 2023 and who developed venous thromboembolism within 3 months of hospital admission.

The exclusion criteria included patients aged <18 years, patients already on anticoagulants at admission, cancer-associated thrombosis, and patients whose admitting diagnosis was not hospital-acquired VTE. Patients with VTE at admission were also excluded from the study.

2.4. Statistical Analysis

Statistical Process Control (SPC) was employed to analyze and interpret the data, combining time series analysis with a graphical presentation of the data. This method often provides insights about the examined data in a much simpler and faster format. Control limits were determined based on process capabilities. In contrast, specification limits were determined according to the research requirements to enable easier identification of statistically significant changes in the data. Dotted lines (process limits) were used to represent the expected range of data points, with the assumption that variation would remain within expected parameters, specifically normal limits.

2.5. Diagnosis and Reporting of VTE

A radiologist diagnoses deep vein thrombosis (DVT) through Doppler venous ultrasound and identifies pulmonary embolism (PE) using a computerized tomography (CT) scan pulmonary angiogram. After making the diagnosis, the radiologist informs the IAFH VTE coordinators. The coordinators then meet with the patient, examine their medical records, conduct interviews, and evaluate risk factors that may have led to the development of VTE. If the patient is readmitted within 90 days, the case will be classified as hospital-acquired VTE.

3. Results

Between January 2018 and July 2023, roughly 33,237 patients were admitted to Imam Abdulrahman Al Faisal Hospital. During this period, high-risk individuals, including adults over the age of 18 years and pregnant women, were regularly reassessed. These reassessments were carried out every 24 h to track the patients’ progress and adjust their treatment plans as required. The primary physician ensured that patients were informed about the benefits, risks, and potential complications of prophylactic measures.

Based on the assessment findings, the healthcare providers utilized the standardized VTE Risk Assessment Tool to evaluate each patient and tailor the prophylaxis decisions based on each patient’s risk score. Among the admitted patients, 11 cases of hospital-acquired VTE were identified. Remarkably, no VTE cases were reported among OB-Gyne patients during the study period.

In

Table 1. Total number of patients admitted to IAFH from January 2018 to July 2023 (n = 33,237) with and without Hospital Acquired Venous Thromboembolism (HA-VTE).

Age/Gender	Without HA-VTE	Developed HA-VTE	Total Count
18–40	28,946	7	28,953
Female	15,803	3	15,806
Male	13,143	4	13,147
41–60	2440	2	2442
Female	1171	0	1171
Male	1269	2	1271
61–74	1180	0	1180
Female	541	0	541
Male	639	0	639
75 or older	660	2	662
Female	327	2	329
Male	333	0	333
Grand Total	33,226	11	33,237

, the total number of patients admitted to IAFH from January 2018 to July 2023 is shown. A total of 33,237 patients were admitted to the hospital during the study period. Of these patients, 11 developed VTE during their hospital stay, with the remaining 33,226 patients not developing the condition. Among the patients who developed VTE, seven were between 18 and 40 years of age (n = 28,953), with this figure including three females and four males.

Additionally, two male patients in the 41–60 age group (n = 2442) developed VTE, and two women developed the condition in the 75-and-older group (n = 662).

Lastly, there were no reported cases of VTE in the 61–74 age group (n = 1180).

The results presented in the

Table 2. HA-VTE (Hospital-Acquired Venous Thromboembolism) patients’ diagnosis, demographics (age and sex), length of stay, type of VTE acquired, type of prophylaxis used during hospitalization, contraindications to pharmacological prophylaxis, and factors that lead to the development of VTE during their hospital stay (n = 11).

Diagnoses	Age/Sex/LOS	PE/DVT	VTE Prophylaxis	Contraindication	Risk Factors for VTE
DKA and ARF, with acute psychotic episodes and delirium; on dialysis treatment; readmitted	50 years old, female, 30 days	DVT (2018)	Pharmacological prophylaxis (heparin 5000 IU TID SC)	Thrombocytopenia	- Obesity - Patient discharged without VTE prophylaxis
COPD, IHD, LVF, and gastritis; readmitted	85 y/o, male, 47 days	PE (2019)	Enoxaparin 60 mg Q12H SC and SCD	None	- Patient discharged without VTE prophylaxis - Delayed prophylaxis for the patient (2 h) - Heart and lung disease - Old age
Early femur fracture fixation within 24 h reduces pulmonary complications; ORIF operation	22 y/o, male, 36 days	PE (2020)	SCD	Active bleeding	- Fracture and past surgery
COVID-19, HTN, bronchial asthma, and surgical history of right femur fracture and internal fixation	74 y/o, female, 18 days	DVT (2021)	Pharmacological prophylaxis	None	- Limited mobilization of the patient - Fracture and surgery - Old age
COVID-19 with severe complications; bed-bound	48 y/o, male, 15 days	DVT (2021)	Heparin infusion as per the DVT protocol	None	- Limited mobilization of the patient
COVID-19 with HTN, DM, iron deficiency anemia, and asthma	58 y/o, female, 18 days	DVT, suspected PE (2021)	Pharmacological prophylaxis (heparin 5000 IU TID SC) and SCD	None	- Limited mobilization of the patient - Lung disease
ARDS and COVID-19 and on a mechanical ventilator; DM, HTN, bronchial asthma, and hypothyroidism; MRSA (+); bedridden with a pressure ulcer	78 y/o, female, 63 days	DVT (2022)	Pharmacological prophylaxis (heparin infusion as per the protocol) and then switched to SCD	Active bleeding	- Old age - Limited mobilization of the patient - Lung disease
Sepsis with respiratory symptoms and hypoxia with a history of DM, HTN, old CVA, and dementia; bedridden patient	92 y/o, female/obese, 29 days	DVT (2023)	Pharmacological prophylaxis (Heparin 5000 TID IU SC)	None	- Delayed CT and administration of first heparin dose - Old age - Limited mobilization - Lung disease
RTA, multiple traumas, bilateral lung contusions, and fracture of the left tibia Compartment syndrome Status-post (S/p) fasciotomy and external fixation	56 y/o, male, 15 days	PE (2023)	Enoxaparin 40 mg Q12h SC and pneumatic compression device	Surgery	- Bed-bound due to multiple trauma; surgery - Delayed administration of VTE prophylaxis since the patient underwent an operation
Perforated acute appendicitis S/P abdominal wash and exploration	40 y/o, male, 20 days	DVT (2023)	Enoxaparin 90 mg SC q12H	None	- Incorrect VTE reassessment scoring - Limited ambulation of the patient
Nephrotic syndrome; readmitted	26 y/o, male, 13 days	PE (2023)	Enoxaparin 40 mg SC OD	None	- Incorrect VTE reassessment scoring - inadequate discharge medication VTE prophylaxis - On bedrest

above show that the majority of HA-VTE patients are older adults. Patient ages ranged from 22 to 92 years, with 63.6% (7/11) of patients being aged 50 or older, which is consistent with the recognized higher risk of VTE in older populations. In terms of sex, 54.5% (6/11) of the patients were female and 45.5% (5/11) were male. Regarding the type of VTE acquired, 63.6% (7/11) of patients developed deep vein thrombosis (DVT), whereas 36.4% (4/11) developed pulmonary embolism (PE). The predominance of DVT is common in hospitalized patients with limited mobility; in comparison, PE was more frequently observed in patients with additional complications such as requiring surgery or severe infections such as COVID-19. The findings also show that varying degrees of VTE prophylaxis were implemented in 11 patients in response to different risk factors. Pharmacological prophylaxis was utilized in most cases; however, several patients faced contraindications such as thrombocytopenia or active bleeding. Notably, many patients were discharged without appropriate VTE prophylaxis despite being at risk.

The duration of hospitalization was also recorded, with 54.5% (6/11) of patients having a hospital stay of 13–20 days, 18.2% (2/11) of patients having a hospital stay of 21–30 days, and 27.3% (3/11) of patients having a hospital stay of 31 days or more. The ALOS of the 11 patients was 27.6 days, which is longer than that of patients who did not develop HA-VTE with an ALOS of 3–7 days. These results suggest that longer hospital stays increase the risk of developing VTE. In light of these findings, healthcare providers implemented appropriate VTE prevention measures, particularly for patients with extended hospital stays, to mitigate this risk and improve patient outcomes. The above findings are supported by the results of a number of studies that have shown that prolonged hospitalization increases the risk of developing VTE, as immobility and other factors associated with hospitalization can lead to the formation of blood clots.

In

Table 3. HA-VTE Incident Report From April 2018 to January 2023.

Mean observation $\overline{\mathrm{X}}$	0.4
Average moving range $\overline{\mathrm{m}\mathrm{R}}$	0.7
Three sigma 3σ	1.8
Upper process limit (% expressed as decimals)	−1.49/2.20
Upper moving range limit	2.3

Upper Control Limits (UCLs) and Lower Control Limits (LCLs) for both the individuals (I) chart and moving range (MR) chart: UCL for I chart = μ + (3 × 3σ) = 0.4 + (3 × 1.8) = 5.8; LCL for I chart = μ − (3 × 3σ) = 0.4 − (3 × 1.8) = −5.0; UCL for MR chart = MR⁻ × UMRL = 0.7 × 2.3 = 1.61; LCL for MR chart = MR⁻/UMRL = 0.7/2.3 = 0.30.

and Figure 1, the number of HA-VTE incidents from April 2018 to January 2023 is shown, with the results indicating a stable trend and expected outcomes with some deviation from the target. The mean observation was 0.4, with an average moving range of 0.7. In February 2023 (2/544), however, there was a special cause for concern necessitating a root cause analysis (RCA) and the implementation of corrective action plans to address all identified and confirmed HA-VTE cases.

In the first quarter of 2021, the VTE coordinators conducted regular awareness programs, increasing HA-VTE case reporting. This approach also resulted in the healthcare staff becoming more vigilant and knowledgeable about the early signs and symptoms of HA-VTE, as reflected in the trend of incidents during the study period.

In Figure 2, the number of VTE-related OVRs from 2018 to 2023 is shown. The results presented in the graph indicate that the number of VTE-related OVRs increased on an annual basis, showing a general upward trend. Based on these findings, there were a total of 70 OVRs raised in 2018 regarding VTE, with this number increasing to 75 in 2019, increasing to 87 in 2020, and rising further to 92 in 2021. A peak was observed in 2022, with the number of VTE-related OVRs surging to 261. During the first half of 2023, the VTE Taskforce documented 150 OVRs during their ward rounds and reviews of patient records. IAFH actively encourages the prompt reporting and investigation of OVRs for all incidents and reassures staff that reporting will not result in disciplinary action. Given that VTE is classified as a reportable event, an OVR is submitted to the patient safety team immediately after a patient is confirmed to have developed VTE during hospitalization.

4. Discussion

In this large-scale real-world retrospective longitudinal study, we examined the impact of active monitoring on the VTE management practices of healthcare providers from 2018 to 2023 to improve patient outcomes. We found that most patients, regardless of whether they were receiving surgical or medical treatment, did not develop VTE during their hospital stay because of the active monitoring and regular education sessions provided by the VTE Taskforce. The findings revealed a particular vulnerability among patients aged 18–40 years, with 7 out of 33,237 patients in this age group developing hospital-acquired VTE (HA-VTE). Among those who developed HA-VTE, 6 out of 11 were male. Furthermore, deep vein thrombosis (DVT) was the most frequently reported form of HA-VTE, accounting for 7 out of the 11 cases.

4.1. VTE Taskforce Committee

IAFH has established an active VTE committee to enhance VTE management and prevention at the hospital. This committee is primarily responsible for regularly reviewing VTE-related data, actively monitoring and educating patients during ward rounds, reporting VTE incidents, and communicating findings to hospital leaders to identify and address areas for improvement.

In addition, daily consultant rounds are conducted at IAFH to ensure prompt updates on the condition of patients and present care plans and critical radiology findings for prompt immediate action. To reduce the risk of VTE, IAFH has established policies, procedures, and guidelines that address prevention in high-risk groups, such as reducing the incidence of VTE in pregnant/postpartum women and adult patients admitted to hospital. The hospital’s guidelines also cover the prevention of VTE in surgical patients, those undergoing antithrombotic therapy, medical patients, long-distance travelers, and stroke patients. The guidelines include recommendations for intermittent pneumatic compression devices to reduce the risk of VTE. Furthermore, VTE coordinators ensure that these policies are followed. They regularly re-educate staff on policies and protocols and address issues such as the inadequate supply of essential equipment for patient care, especially those at risk of HA-VTE.

In the study, describe how VTE committees comprise hospital employees and staff dedicated to reducing VTE risks among patients [18]. In line with our findings, a report on a multidisciplinary task force formed at Sheikh Khalifa Medical City (SKMC) in Abu Dhabi to enhance compliance with VTE risk assessment and evaluate its outcomes [13]. The findings of their study revealed that this task force successfully implemented quality improvement strategies that significantly improved compliance with electronic VTE risk assessments for general medicine patients. These changes enhance patient safety and prevent avoidable harm.

In a similar vein, a study described how a multidisciplinary VTE committee was initiated at Saint Francis Hospital in Tulsa, Oklahoma, to implement a hospital-wide quality improvement (QI) program [19]. The goal of this program was to standardize how VTE risk assessments and prophylaxis prescriptions were addressed. The authors found that the program was effective because of the teamwork between committee members, support from physician champions, a variety of communication and education approaches, and the use of evidence to substantiate any changes made.

Beyond these measures, IAFH places great importance on educating patients, with regular educational sessions conducted by physicians, nurses, and VTE coordinators to ensure that patients are adequately informed about the risk of acquiring VTE, prevention methods, and signs and symptoms of DVT/PE. A multilingual pamphlet (Figure 3) regarding VTE is provided to each patient to help them better understand the disease. Furthermore, patients who receive pharmacological prophylaxis are given explanations about the benefits and risks of their prescribed medication to enable informed decision-making by patients. The VTE Taskforce of IAFH also ensures that healthcare staff have accurate and up-to-date information about each patient’s care plan and risk factors. Attending physicians and nurses provide comprehensive education on DVT/PE prevention and management. They take the lead in this regard and document information in the patient education form (Figure 3). Such measures ensure that key information is consistently communicated to patients and their families. To prevent DVT development, post-operative patients are actively encouraged and supported in early ambulation.

Access to precise and reliable health information is important in enabling patients to make informed decisions and actively participate in their care [3]. Providing timely targeted education can significantly reduce the failure to administer VTE prophylaxis in hospitalized patients, which improves healthcare quality through the utilization of real-time data to focus on at-risk individuals [20].

The authors found that pharmacist-led personalized education sessions resulted in better medication adherence to injectable VTE prophylaxis prescribed by clinicians and decreased the number of patients refusing prophylactic treatment [21].

In contrast with these findings, the results of a study revealed a lack of VTE awareness and understanding of its prevention among hospitalized patients in Yemen. Patients who were unaware of the condition were noted as often having misconceptions about their role in DVT prevention [22].

4.2. VTE Risk Assessment Method (RAM) Compliance, Appropriateness, Score, and Prophylaxis

IAFH’s routine assessments cover all factors influencing patient care. All adult patients admitted to the hospital are assessed for VTE risk using the VTE risk assessment tool. This evaluation is conducted upon admission or during the pre-operative assessment for elective surgical patients. Radiologists are responsible for reporting cases of DVT/PE to the IAFH VTE coordinators who then interview the patients and review their medical records. If the patient is readmitted within 90 days, their condition is considered hospital-acquired VTE. In Figure 4, the results for VTE RAM compliance, prophylaxis, and appropriate score are displayed, with the results demonstrating that the hospital has consistently reached or even exceeded the benchmark in the past 5 years, reflecting the commitment of IAFH to effective VTE prevention and management.

A study, that various VTE risk assessment models (RAMs) have been created and validated for at-risk groups, including hospitalized patients with medical or surgical conditions, cancer patients, and pregnant women. Research shows that using these RAMs consistently leads to higher prophylaxis rates and reduces the overall burden of VTE [23]. For instance, a study found that VTE assessment compliance was similar among medical and surgical patients, with 78% and 80% of individuals in each group being assessed [24].

However, the authors noted significant differences in prescribing thromboprophylaxis: 33% of at-risk surgical patients received prophylaxis, with prophylactic treatment noted in only 14% of at-risk medical patients.

IAFH uses a structured approach to prevent VTE through risk assessment tools for specific patient groups. The Adult Risk Assessment Form (Figure 5) is used to assess the risk of DVT for both medical and surgical patients. In addition, the hospital utilizes Antenatal and Post-Natal Assessment Forms (Figure 5) to assess admitted pregnant and post-delivery patients. IAFH ensures 100% compliance with VTE risk assessments and ensures that all patients admitted to the hospital undergo proper evaluation. This process is documented in patients’ medical records or completed electronically to ensure a standardized assessment for all patients, including those at high risk, helping physicians to identify VTE prevention needs promptly. Timely and accurate assessment, scoring, and prophylaxis administration are therefore important in effective VTE risk management upon admission.

VTE risk assessment is a practical tool in healthcare that identifies patients at risk of VTE. Widely used risk assessment models are often featured in clinical guidelines or backed by evidence from studies or real-world practice. These models guide interventions aimed at preventing VTE by identifying patients at risk [25]. It should be noted, however, a study found that the accuracy and predictive performance of the RAMs studied are limited, raising doubts about their clinical value [26]. They emphasize the need for more precise methods to predict VTE risk in medical inpatients and more research to evaluate how well these tools work in practice.

4.3. VTE Risk Stratification and Risk Factors Vary Among Different Populations

All patient-related factors are given careful consideration when selecting prophylactic treatment, particularly for patients with a heightened risk of bleeding, such as postpartum women. In such cases, pharmacological thromboprophylaxis is avoided, delayed, or discontinued as clinically indicated. These initiatives have resulted in no cases of VTE among pregnant, post-CS, and post-delivery patients, highlighting the effectiveness of the hospital’s current VTE management practices. In addition, all patients aged 18 years or older are reassessed for VTE risk every 24 h or whenever clinical changes occur.

VTE prophylaxis is customized to patients based on their VTE risk score. Patients at low risk (score of zero to one) do not require prophylaxis, moderate-risk patients (score of two) may receive pharmacological prophylaxis, and high-risk patients (score of three to four) undergo physician assessment to determine the need for either pharmacological or mechanical prophylaxis. Lastly, it is recommended that patients with the highest risk (score of five) receive both mechanical and pharmacological prophylaxis.

The hospital has achieved a score of over 99% overall, which allows for interventions to be made according to the severity of the scores. The staff at IAFH are well-informed about proper VTE prophylaxis and are well trained in the use of Sequential Compression Devices (SCDs). If SCDs are unavailable or do not work properly, the staff promptly report such issues to department heads, raise OVRs to inform responsible departments, and notify hospital leaders of potential patient care compromises. SCDs are always available and effectively maintained for patient-centered care and safety.

Despite increased patient admissions compared to previous years, IAFH has maintained exceptionally high-quality standards of patient care and services. Notably, the hospital has further enhanced its value-based service delivery, even amidst the increased patient volume. This improvement reflects the hospital’s proactive initiatives and adaptive strategies aimed at reducing the incidence of VTE.

Furthermore, all healthcare professionals at IAFH ensure comprehensive VTE management by performing daily patient rounds and thoroughly reviewing patient files. Patients and staff are also empowered with knowledge through regular education sessions on VTE, and hospital-acquired VTE incidents are actively reported for immediate intervention and continuous improvement in patient safety protocols.

The efficiency of VTE prevention strategies implemented at IAFH is reflected in the lower incidence of VTE events, and with active monitoring and reporting, the number of patients developing HA-VTE has decreased. Early detection and management of DVT/PE are also handled immediately, resulting in decreased lengths of stay and improved hospital efficiency and value-based care provided during hospitalization. Consequently, complications such as post-thrombotic syndrome, recurrent VTE, and major bleeding events have markedly decreased, demonstrating improved patient safety and efficiency of patient services at IAFH.

The distribution of established VTE risk factors changes depending on the age at which VTE occurs. Advanced age is the most significant and common risk factor for experiencing a first venous thromboembolic event [27]. The decision to administer prophylaxis should be made taking into account the VTE risk, age, and life expectancy of each patient. Prophylaxis is generally unnecessary for most patients with a 3-month VTE risk below 1.0%. Given that most patients have a risk lower than 1%, offering prophylaxis to all patients would not be an efficient use of resources. Moreover, for patients with an estimated VTE risk under 0.26%, prophylaxis can in fact be harmful and should be avoided [25].

In their study discuss how medical personnel’s knowledge of VTE prophylaxis is of significant importance in the effectiveness of prophylaxis [16]. Poor knowledge of VTE prevention strategies may lead to inconsistent practices, potentially increasing VTE rates among hospitalized patients. Another study support this finding and highlight in their study how research has shown that implementing effective VTE prevention strategies can reduce VTE incidence by up to 70% [27]. For instance, VTE prevention and treatment protocols have been successfully applied in hospitals in the United States, resulting in a reduction in the rates of VTE.

4.4. Advantages and Limitations of the Study

As part of this study on active monitoring in VTE management at Imam Abdulrahman Al Faisal Hospital, conducted over a period of six years, we aimed to examine the occurrence of VTE among hospitalized patients and consider the seasonal variations in disease incidence. We found that continuous education, patient rounds, and awareness among healthcare staff increased vigilance and active reporting of VTE-related cases in the hospital. Such measures resulted in timely assessment and administration of appropriate prophylaxis, which aided in reducing the risk of VTE during hospitalization. In addition, the active monitoring system implemented during the study period has enhanced adherence to evidence-based guidelines, and the use of risk assessment tools has enabled more tailored prophylactic measures, improving patient outcomes and reducing VTE complications.

It should be noted, however, that we did not focus on the specific risk factors that contribute to hospital-acquired VTE nor did we investigate the differences between patients who developed VTE while hospitalized and those who developed the condition following discharge. Additionally, the study also faces limitations in that it was based on retrospective data, meaning that it may not capture all variables influencing patient outcomes. This study comprises a single-center design, and patients underwent multiple dynamic assessments during their hospital stay because of the changes in their condition and treatment. Furthermore, the researchers also faced challenges regarding limited workforce and funding, meaning that they could not follow up with patients following discharge. As a result, we were unable to collect data on VTE-related events that might have occurred within three months of the patient’s discharge. Such a limitation may have led to an underestimation of the actual VTE rate compared to the rate reported.

5. Conclusions

In conclusion, the results presented in this study demonstrate the significant impact of active monitoring on VTE management and patient outcomes. They show the significance of the active role of VTE coordinators in monitoring the HCPs’ practices in VTE risk assessment for achieving improved patient outcomes and delivering efficient, value-based, and high-quality care at Imam Abdulrahman Al Faisal Hospital. The findings showed that, as a result of the active monitoring and prevention strategies implemented by the hospital, most patients did not develop VTE. It should be noted that VTE cases were more common among older adults with prolonged hospital stays, with deep vein thrombosis (DVT) being the most frequently reported type.

Furthermore, the increase in reported cases of hospital-acquired VTE does not necessarily translate into declines in the quality of care and services. Instead, this increase shows that healthcare providers are better able to identify and report these cases promptly. IAFH is currently focusing on more patient-centered and proactive approaches, teamwork measures, and ongoing efforts to improve the quality of its VTE management strategies. The hospital VTE task force has significantly improved patient safety and prophylaxis through ongoing education and routine hospital rounds. It has also improved the way in which risks are assessed and how prevention strategies are applied to reduce the incidence of preventable VTE cases that occur in the hospital. Such measures also reduce the risk of complications associated with VTE and improve patient care by enabling patients to recover faster. As a result, patients are now spending less time in hospital or intensive care, resulting in savings in healthcare costs. To maintain these positive results, it is vital to remain vigilant, prioritize education, and follow established guidelines and protocols for preventing VTE.

IAFH’s effective efforts to lower VTE risk point to the success of its VTE prevention and management protocols. Moreover, the education and training provided at the hospital, combined with safety campaigns and improving the healthcare providers’ understanding of and adherence to practice guidelines, strongly emphasizes its commitment to managing VTE and patient care.