Improving adherence to venous thromboembolism prophylaxis using multiple interventions

In hospital, deep vein thrombosis [DVT] increases the morbidity and mortality in patients with acute medical illness. DVT prophylaxis is well known to be effective in preventing venous thromoembolism [VTE]. However, its use remains suboptimal. The objective of this study was to evaluate the impact of quality improvement project on adherence with VTE prophylaxis guidelines and on the incidence of hospital-acquired VTEs in medical patients. The study was conducted at Saudi Aramco Medical Services Organization from June 2008 to August 2009. Quality improvement strategies included education of physicians, the development of a protocol, and weekly monitoring of compliance with the recommendations for VTE prophylaxis as included in the multidisciplinary rounds. A feedback was provided whenever a deviation from the protocol occurs. During the study period, a total of 560 general internal medicine patients met the criteria for VTE prophylaxis. Of those, 513 [91%] patients actually received the recommended VTE prophylaxis. The weekly compliance rate in the initial stage of the intervention was 63% [14 of 22] and increased to an overall rate of 100% [39 of 39] [P=0.002]. Hospital-acquired DVT rate was 0.8 per 1000 discharges in the preintervention period and 0.5 per 1000 discharges in the postintervention period, P=0.51. However, there was a significant increase in the time-free period of the VTE and we had 11 months with no single DVT. In this study, the use of multiple interventions increased VTE prophylaxis compliance rate

Pandemic influenza A [2009 H1N1] in hospitalized patients in a Saudi Arabian hospital: Epidemiology and clinical comparison with H1N1-negative patients

The World Health Organization [WHO] declared that pandemic influenza A [H1N1] was a public health emergency of international concern in April 2009. Herein, we describe the characteristics of patients in a Saudi Arabian hospital with and without H1N1 infection. We reviewed the records of patients admitted with influenza-like illness and compared confirmed pandemic H1N1 cases to the H1N1-negative patients admitted to the hospital. Infections due to the novel H1N1 virus were confirmed using real-time reverse transcriptase polymerase chain reaction [rRT-PCR]. During the study period, a total of 165 patients were admitted with influenza-like illness and underwent rRT-PCR testing. Of these patients, 47 [28.4%] had confirmed novel H1N1 virus infection. Thus, the hospitalization incidence rate was 13.4 cases per 100,000 persons. The remaining patients had negative H1N1 rRT-PCR test results. The mean age +/- SD of the H1N1-positive patients was 30.3 +/- 28.5 years compared with 25.3 +/- 23 years for the H1N1-negative group [P=0.28]. Severe obesity was observed in 6.7% and 8.5% of H1N1-positive and H1N1-negative patients, respectively [P=0.74]. The clinical picture was similar between the two groups, except for the higher prevalence of nausea [25.5% vs. 11%] and diarrhea [21.3% vs. 7.6%] in the H1N1-positive group than in the H1N1-negative group [P=0.03] The mortality rate was low in both groups. The clinical presentation and outcome are insufficient to differentiate between influenza-like illness [ILI] caused by H1N1 and that cause by other pathogens. In general, both groups had mild disease in this cohort of patients in Saudi Arabia