ArticleScientific reports2026
Optimizing venous thromboembolism risk management through the PDCA cycle: a single-center before-and-after controlled study.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Venous thromboembolism (VTE) is a leading cause of preventable in-hospital mortality globally, with suboptimal adherence to clinical preventive guidelines. This study aimed to develop a systematic VTE risk management intervention based on the Plan-Do-Check-Act (PDCA) cycle, quantify its efficacy in improving management quality, and provide a replicable framework for healthcare institutions. A before-and-after controlled study was conducted in 5 high-VTE-risk departments (Interventional Vascular Surgery, Respiratory Medicine, Gynecology, Geriatrics, and Trauma Orthopedics) of a tertiary general hospital in Ningxia, China, from January 2022 to December 2023. Patients admitted in 2022 (n=8752) served as the control group, receiving routine guideline-based VTE management without structured improvement mechanisms. Patients admitted in 2023 (n=9163) constituted the intervention group, undergoing PDCA-driven interventions (multidisciplinary collaboration [MDT], digital integration, and standardized processes) identified via root cause analysis (fishbone diagram combined with Pareto analysis). Interrupted time-series analysis and multivariate logistic regression (adjusting for age, sex, department, and case-mix index) were used to strengthen causal inference. Baseline characteristics were balanced between groups (all P>0.05). After confounder adjustment, key indicators in the intervention group were significantly improved (all P<0.001): VTE preventive measure implementation rate increased from 23.84% to 67.43% (absolute increase: 43.59%, 95% CI: 41.27%-45.91%; adjusted OR=7.92, 95% CI: 7.21-8.71); hospital-acquired VTE incidence decreased from 4.63% to 2.74% (absolute decrease: 1.89%, 95% CI: 1.26%-2.52%; adjusted OR=0.52, 95% CI: 0.44-0.62); 24-hour VTE risk assessment rate rose from 36.04% to 91.06% (adjusted OR=16.83, 95% CI: 15.12-18.75). No significant differences were observed in major/minor bleeding incidence or VTE mortality between groups (all P>0.05). The PDCA cycle effectively enhances VTE risk management by addressing core barriers (information fragmentation, insufficient personnel cognition, and non-standardized processes). Its integration with digital tools and MDT forms a clinically valuable, replicable model, with feasible adaptations for lower-resource settings, thereby narrowing the global "guideline-practice gap" in VTE prevention.
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