Preventing Hospital-Associated Venous Thromboembolism (VTE): A Public Health and Patient Safety Challenge
Deep venous thrombosis (DVT) is a blood clot in a large vein, usually in the leg or pelvis. Sometimes a DVT breaks free from where it formed and begins to move through the bloodstream. If the clot moves through the heart to the lungs it can block an artery supplying blood to the lungs. This condition is called pulmonary embolism (PE). The disease process that includes DVT and/or PE is collectively called venous thromboembolism (VTE). VTE is a major public health problem, with hundreds of thousands of people affected each year. Because almost half of all VTEs are hospital-associated (HA-VTE) -- that is, they occur during or soon after a hospital stay, VTE is both a public health problem and a preventable patient safety problem. Despite additional attention given to HA-VTE, the number of secondary diagnoses of VTE in hospital patients has increased, and during 2007-2009 an average of almost 550,000 adult hospital stays each year had a discharge diagnosis of VTE. Public health programs and organizations concerned with patient safety (for example, hospital networks and healthcare payers) should work together to:
- Promote tools that identify and predict which patients are at high risk, or likely to be at high risk, for VTE, and prioritize the management of their care in order to prevent poor health outcomes,
- Promote VTE prevention in inpatient settings, and
- Study trends in both the use of risk-appropriate methods in hospitals to prevent VTE (known as prophylaxis) and the occurrence of HA-VTE and related health problems.
HA-VTE is the subject of a number of patient safety and public health programs developed and promoted by federal agencies. This topic was the focus of the January 15, 2013 Public Health Grand Rounds and the information presented was summarized in a recent Morbidity and Mortality Weekly Report. Highlighted below are just a few of the patient safety and public health programs:
The Johns Hopkins Experience – A Successful Patient Safety Quality Improvement Program
- Beginning in 2004, the Johns Hopkins Medical Institutions developed a VTE education program for care providers, designed VTE prophylaxis strategies, created a plan to measure progress, and reviewed data with staff to improve performance. Paper forms were developed for physicians to record patient risk assessments and doctors’ orders for prophylaxis.
- A computer-based system was subsequently put in place to help providers make decisions about the appropriate use of VTE prophylaxis for both surgical and medical patients. Following this change, prescription of risk-appropriate VTE prophylaxis increased to more than 85%, and all surgical and medical patients were assigned a level of risk for VTE in order to prioritize the management of their care.
- A before-after study of outcomes for medical patients noted a 67% decrease in the frequency of VTE within 90 days of hospital discharge, from 1 in 40 to about 1 in 150; there was no increase in major bleeding events during hospitalization.
Other HA-VTE Focused Patient Safety Programs
- VTE is one of nine hospital-acquired conditions targeted for an overall 40% reduction by the Partnership for Patients, a joint national healthcare quality initiative led by the Centers for Medicare and Medicaid Services (CMS).
- The Agency for Healthcare Research and Quality (AHRQ) works in partnership with CMS to promote a culture of patient safety and to monitor trends in harms that occur during patient care. VTE-specific activities include
- Production of information guides for patients and consumers on how to prevent blood clots and dangers to be aware of when taking blood thinners.
- Updating of a VTE-prevention guide containing sample forms and protocols for care providers to use in carrying out processes to prevent HA-VTE.
CDC Public Health Efforts to Prevent HA-VTE
- In 2011, CDC held an expert panel to discuss prevention of HA-VTE. The experts identified the need for strategies to address the use of VTE prophylaxis among hospital patients and better ways to track HA-VTE.
- In 2012, CDC funded 2 pilot programs for a two-year period to monitor the rate of HA-VTE. These two programs will help CDC:
- To develop methods that combine use of administrative data (such as hospital discharge data) with review of electronic medical records, allowing CDC to better estimate the true rate of HA-VTE
- To inform the development of monitoring methods that overcome challenges related to determining the rate of HA-VTE, since HA-VTE can occur either during a hospital stay or after hospital discharge.
- CDC works with partners to develop and share information to improve awareness of VTE and methods of preventing or managing blood clots, including information for patients and care providers
To learn more about CDC’s activities on this subject, please visit DVT website.
To find other organizations that focus on this subject, please visit http://www.cdc.gov/ncbddd/dvt/links.html or to obtain free resources on DVT/PE, please visit: http://www.cdc.gov/ncbddd/dvt/freematerials.html.
Centers for Disease Control and Prevention (CDC). CDC Grand Rounds: Preventing Hospital-Associated Venous Thromboembolism, 2014. MMWR Morb Mortal Wkly Rep. 2014;63(9):190-193.
A secondary diagnosis is not the main reason that a patient was admitted to the hospital. It is either an additional reason for hospital admission or a new diagnosis that was made during the hospital stay.