Optimizing Venous Thromboembolism Risk Management through the PDCA Cycle: A Single-Center Before-and-After Controlled Study

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.