# Clinical Audit on Venous Thromboembolism (VTE) Risk Assessment and Guideline Adherence in Surgical Practice

## TL;DR

This study shows how simple interventions can improve VTE prevention practices in a Sudanese hospital by adapting international guidelines to local conditions.

## Contribution

The study adapts international VTE prevention guidelines to a Sudanese hospital context, offering a feasible model for low-resource settings.

## Key findings

- Caprini score calculation improved from 91.8% to 100% after interventions.
- Documentation of prophylaxis duration increased significantly from 44.9% to 90.6%.
- Patient education rates rose from 28.6% to 81.1% following the interventions.

## Abstract

Background: Venous thromboembolism (VTE) is a leading cause of preventable complications among surgical inpatients, yet compliance with risk assessment and prophylaxis often falls short, particularly in resource-limited settings. This audit aimed to evaluate and enhance VTE prevention practices through structured interventions.

Methods: A closed-loop audit was performed in two cycles: an initial baseline assessment of 49 surgical inpatients, followed by a re-audit of 53 patients after implementing targeted interventions. Surgical inpatients were assessed using an evidence-based proforma adapted from international guidelines. Interventions included staff education, standardized documentation tools, visual reminders, and electronic prompts. Outcomes focused on the completion of risk assessments, appropriateness of prophylaxis, and delivery of patient education.

Results: Caprini score calculation improved from 45/49 (91.8%) in the first cycle to 53/53 (100%) in the second (p = 0.107). Documentation of prophylaxis duration rose significantly from 22/49 (44.9%) to 48/53 (90.6%, p < 0.001). Guideline-consistent management plans increased from 23/49 (46.9%) to 45/53 (84.9%, p < 0.001). Patient education demonstrated the largest significant improvement, from 14/49 (28.6%) to 43/53 (81.1%, p < 0.001). Doctors’ awareness and adherence to appropriate prophylaxis also improved, with elimination of inappropriate use in low-risk patients and a substantial rise in extended prophylaxis for high-risk cases.

Conclusion: This audit demonstrates that low-cost, multifaceted interventions can strengthen VTE prevention in a resource-limited Sudanese hospital. The unique contribution of this study lies in adapting international guidelines to the Sudanese hospital context, thereby offering a feasible and context-sensitive model for comparable low-resource settings. Sustained improvement will require standardized tools, continuous education, and regular re-auditing.