Objective: Deep vein thrombosis (DVT) prophylaxis remains underused in hospitalised medical patients despite strong recommendations that at-risk patients should receive prophylaxis.  To understand this gap between knowledge and practice, we surveyed clinicians' perceptions about the importance of DVT prophylaxis, barriers to guideline implementation, and interventions to optimise prophylaxis.

Methods: Paper- and electronic mail-based surveys were sent to 1553 internists, nurses, pharmacists and physiotherapists in Ontario, Canada.  Responses were scored on 7-point Likert scales.  An important barrier to optimal DVT prophylaxis was one with a mean score of 5 or higher, and interventions with high potential success or feasibility were those with mean scores of 5 or higher.

Results: DVT prophylaxis was perceived as important by all clinician groups but this did not appear to translate into knowledge about underutilisation of current DVT prophylaxis strategies.  Physicians and pharmacists recognised the underuse of DVT prophylaxis in medical patients, while nurses and physiotherapists tended to perceive prophylaxis strategies as appropriate.  Lack of clear indications and contraindications for prophylaxis and concerns about bleeding risks were perceived as important barriers.  Preprinted orders were considered the most potentially successful and feasible way to optimise prophylaxis.

Conclusions: A considerable barrier to optimal DVT prophylaxis utilisation may be that those healthcare providers best able to conduct a daily assessment of patients' need for prophylaxis under-recognise the problem that prophylaxis is underutilised in this population.  Interventions to bridge the gap between knowledge and practice should consider preprinted orders outlining DVT risk factors, and educating front-line care providers prior to implementation of a top-down approach.