Developing a VTE Risk Assessment Video for Clinicians: Including the end user

Written by: Kate O’Callaghan

Venous Thromboembolism (VTE) is one of the most common cardiovascular diseases. This manifests clinically in Deep Vein Thrombosis (DVT), whereby a blood clot forms in the leg and Pulmonary Embolism (PE), which can form insitu or the clot in the leg travels to the lungs (PE). 1, 2 Venous Thromboembolism is a major global burden and with the population aging the incidence of this disease is likely to increase. 3 Reports note that approximately 10 million cases of VTE occur every year, incurring an economic burden, increasing hospital length of stay, the clinician burden, and increase in medication usage. 3 Despite being a potentially preventable disease 4 and with national guidelines in place stating the need to assess for VTE risk assessment for all patients admitted to hospital 5 , pharmacological thromboprophylaxis (PT) is still underutilized. A recent Irish report noted that 70% of hospital acquired VTE (VTE during an admission or 90 days post admission) were preventable. 6 Balancing the need for the thromboprophylaxis with the risk of bleeding and without the use of risk prediction tools, the risk of over or under utilisation of thromboprophylaxis can occur. 7 The inclusion of the end user in the diffusion of healthcare technology has proven to be an important tool that can have a positive influence on the use of VTE risk assessments. 7 With the utilisation of digital health interventions becoming more prominent, the aim of this research was to examine the evidence in relation to the use of digital health as a means to assess risk of VTE and guide evidence-based treatment.

This research is based in part on a final year dissertation for the taught MSc Digital Health course offered by UCC. The title of the research was: Exploring clinicians’ perspectives on the current Venous Thromboembolism risk assessment practices in Cork University Hospital and their acceptability towards an e-learning platform for VTE risk assessments in the future. The second stage of this project now works in collaboration between the Haematology Dept. (Dr Maeve Crowley) in CUH and the Cork University Business School, UCC (Dr Wendy Rowan). The original research was qualitative in nature and aimed at understanding the clinician’s experience of VTE risk and completing the risk assessment in CUH (Image shows some feedback from clinicians). There was a desire to understand if clinicians felt there was more training needed and if so, what would this training look like. After analysing the qualitative data using thematic analysis, the development of a VTE risk assessment video was identified as a need and different elements within the video design were categorised in relation to clinical motivators to prompt and remind clinicians to complete the VTE risk assessment. With the support from the HIHI Spark Ignite Process, and mentorship from Ali Rose Sisk, a successful funding application to the Irish Haemostasis Research Foundation and support from line Managers, there has been the opportunity for this project to continue and develop. The initial prototype of the video has been created and the next step is to obtain feedback from clinicians on the further development and implementation of this video in practice.

From the literature review, there is certain positivity seen in utilising human factor elements, whereby the end user is involved in the implementation of technology, such as the development of a VTE risk assessment and prescription process as a whole. Nwulu et al. (2014) explored education in the utility of the VTE risk assessments and the importance of prophylaxis was seen to improve outcomes in a longitudinal cohort study 9 and the need for increased time in orientation is cited as an improvement that needs to be made. 8 Similarly, in a recent 2019 Brazilian study education was seen to be a positive aspect for on-going research in this area. 10

The next step for this research is to obtain continued support and advice from clinicians. The second phase of the study is based on video development cycles with quantitative feedback from research participants. The 2nd and 3rd iterations of the video prototype will be shown to SHOs at their teaching sessions and their participation in obtaining feedback on the video will be garnered through the completion of a survey tool. This feedback will be used to make further improvements for future iterations and sharing of the video. Once the 3rd version of the video is made clinicians will again be asked to complete the survey with the aim of revisiting the utility and also assessing any potential behavioural changes or intentions to change behaviours from the clinical standpoint. The overarching aim of this project is to include a VTE risk assessment video into clinicians teaching, so that it can be played at each rotation in order to assist clinicians with:

VTE Risk reminders to assess today and tomorrow.

Reducing VTE morbidity and mortality.

Complete the VTE Risk Assessment at Every Admission.

If you are reading this and would like to get involved and offer some support and feedback to this research project, then please contact Kate at: (kate.ocallaghan@hse.ie).

Visit Thrombosis Ireland for further information/resources at www.thrombosis.ie

References available on request

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