Analysis of the Inter-Rater Consistency of VTE Risk Assessment Between Doctors and Nurses: An Exploratory Study at Shanghai East Hospital

Hospital-associated venous thromboembolism (VTE) has become a major cause of unintended death in hospitalized patients, especially during the peri-operative period. Standardized and reasonable prevention measures have been found to effectively reduce its occurrence. This study aimed to analyze the consistency of VTE risk assessment by physicians and nurses and identify the potential causes behind its inconsistency.

A total of 897 patients admitted to Shanghai East Hospital from December 2021 to March 2022 were included in the study. The VTE assessment scores of physicians and nurses, along with the activities of daily living (ADL) scores within 24 hours of admission, were collected for each patient. Cohen’s Kappa values were calculated to assess the inter-rater consistency of these scores.

The study revealed that VTE scores were fairly consistent between doctors and nurses in both surgical and non-surgical departments. However, there was a moderate agreement in VTE risk assessment between doctors and nurses in surgical departments, while fair agreement in VTE risk assessment between doctors and nurses in non-surgical departments. Among non-surgical departments, there were higher degrees of agreement between physicians and nurses in the oncology department, VIP clinical department, and geriatrics department. In surgical departments, there was a higher degree of agreement between doctors and nurses in VTE risk assessment in traumatology.

Furthermore, the assessment of the mobility impairment component was found to be fairly consistent between doctors and nurses (Kappa = 0.31, 95% CI: 0.25–0.37) in non-surgical departments. However, doctors and nurses showed no statistically significant agreement in assessing the thrombosis potential component.

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The study highlights the lack of consistency in VTE risk assessment between doctors and nurses due to several factors, including insufficient awareness of VTE risks, the absence of systematic training, and a lack of standardized VTE assessment processes. Implementation of such prevention measures could help construct scientific and effective VTE prevention and treatment systems.

In conclusion, hospital-associated VTE is a major cause of unintended death in hospitalized patients. Thus, it is essential to provide systematic training and develop standardized assessment processes for healthcare professionals to improve the accuracy of VTE risk assessment, enhance clinical decision-making, and improve early intervention practices for high-risk groups.

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