Abstract 6901: Effect of a Virtual Patient Simulation at Improving VTE Prevention Strategies in Acutely Ill Medical Patients

Abstract

Introduction: Despite evidence and guidelines for VTE prophylaxis in the hospital setting, cardiologists are challenged to implement the latest evidence-based strategies to prevent VTE in clinical care. We sought to determine if an online, virtual patient simulation (VPS)-based continuing medical education intervention could improve performance of cardiologists related to individualized strategies to prevent VTE in these patients. Methods: The intervention comprised two patients presenting in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a McNemar’s test to determine P values. Data were collected from March 27, 2020 through June 10, 2020. Results: Significant absolute improvements were observed after CG for the following: Case 1 (n= 123) • Diagnose high risk for VTE:44% improvement (15% pre-CG vs 59% post-CG; P<.001) • Order/Initiate o Rivaroxaban: 46% improvement (13% pre-CG vs 59% post-CG; P<.001) o Enoxaparin: 13% improvement (7% pre-CG vs 20% post-CG; P<.001) o Post-discharge VTE assessment risk and counseling: 22% improvement (50% pre-CG vs 72% post-CG; P<.001) o Patient education: 20% improvement (50% pre-CG vs 70% post-CG; P<.001) o Follow-up visits: 20% improvement (48% pre-CG vs 68% post-CG; P<.001) Case 2 (n= 80) • Order/Initiate o Rivaroxaban: 28% improvement (35% pre-CG vs 63% post-CG; P<.001) o Enoxaparin: 10% improvement (4% pre-CG vs 14% post-CG; P<.05) o Post-discharge VTE assessment risk and counseling: 12% improvement (63% pre-CG vs 75% post-CG; P<.01) o Patient education: 11% improvement (60% pre-CG vs 71% post-CG; P<.01) o Follow-up visits: 11% improvement (63% pre-CG vs 74% post-CG; P<.01) Conclusions: VPS that immerses specialists in an authentic, patient-based, practical learning environment can significantly improve evidence-based clinical decision making for the prevention of VTE in acutely ill medical patients.