Patient Engagement Improves Compliance with Use of Sequential Compression Devices in a Neurosurgery Patient Population of a Safety-Net Hospital

Introduction: Sequential Compression Devices (SCDs) are utilized in perioperative patients given increased risks of deep venous thrombosis from mobility reductions and post-operative inflammatory responses. Previous work has found SCD compliance remained low, despite implementation of best practice nursing alert. This study aimed to improve SCD compliance in the neurosurgery step-down population by enhancing patient engagement.

Methods: Across 13 months (August ‘22-August ‘23), we tracked SCD compliance in neurosurgical patients in a step-down unit. When not on or properly functioning, the missing element was documented. Compliance was calculated daily out of all patients with SCD orders, then averaged over each month. Most common barriers to compliance were identified. Together with nursing management, we implemented a best practice alert to facilitate nursing education, at month 3. Then, at month 12, we implemented a patient-engagement measure via the creation and distribution of a patient-directed infographic. Data collection occurred over nine months, with a 4-months break from November-February and a 2-month break from May-June.

Results: Compliance averaged 19.7% (n=95) during August, and 38.4% (n=131) in September. After implementing the best practice nursing alert and supply chain upgrades, compliance was 48.8% (n=150) in October, 41.2% (n = 104) in March, and 45.9% (n=76) in April. After distributing the patient-focused infographic, compliance improved to 51.4% (n=70) and 55.1% (n=34) in August. Compliance was significantly increased from baseline in August of 2022 to October (z=4.5838, p< 0.00001), sustained through March of 2023 (z=3.2774, p=0.00104) and further improved by August of 2023 (z=3.9025, p=0.0001).

Conclusion : While implementation of the best practice nursing alert facilitated the sustained improvement in SCD compliance despite breaks in surveillance, SCD compliance nonetheless remained below 50%. Implementation of patient-directed measures to enhance patient engagement improved SCD compliance to over 50%.