Community and Clots: Improving VTE Prophylaxis Prescribing in a Community Rehabilitation Unit

Introduction: Venous thromboembolism (VTE) prophylaxis assessment is a critical but often under-prioritised aspect of inpatient care. In the community rehabilitation setting, this process is particularly nuanced: patients are often frail with complex comorbidities, many patients have had strokes and clinicians have limited information required for safe prescription of VTE prophylaxis including renal function and sufficient details of their recent admission that is more readily available in acute hospital settings. At our community rehabilitation hospital we identified low rates of VTE prophylaxis assessment and prescription accuracy and undertook a quality improvement (QI) project to address this.

Methods: Using QI methodology, the electronic records of 40 randomly selected patients admitted in October-November 2025 were reviewed to establish baseline rates of VTE assessment completion, assessment accuracy according to local guidelines, and prescription accuracy with respect to weight and renal function. Based on local guidelines, we developed a bespoke, easily accessible flowchart to support admitting clinicians' decision-making at the point of prescribing, taking into account the additional considerations required for our patient cohort. This was highlighted to rotating resident doctors at their inductions. Following implementation, we re-audited 40 randomly selected patients admitted in April-May 2026 using the same criteria.

Results: Assessment completion rates improved from 92.5% to 100%. Accuracy of VTE risk assessment improved from 77.5% to 95%. Prescription accuracy relative to patient weight and renal function improved from 60% to 75%.

Conclusion: A simple, guideline-based flowchart tailored to the community rehabilitation setting substantially improved both the completion and accuracy of VTE prophylaxis assessment, as well as prescribing accuracy. Given the added complexity of VTE risk assessment in this population and setting, having a readily available decision support tool is a low-cost and effective intervention to reduce risk and improve patient safety in inpatient community rehabilitation units.