Introduction:

Venous thromboembolism (VTE) is a common complication in patients undergoing surgery.  Postoperative deep vein thrombosis (DVT) of the lower limbs is often asymptomatic; therefore, it is inappropriate to rely on early diagnosis and treatment of postoperative thromboembolism.  In many patients, fatal pulmonary embolism (PE) is the first clinical manifestation of postoperative VTE.1,2  The risk for VTE in surgical patients is determined by the combination of individual predisposing factors and features of the specific type of surgery.  More extended use of prophylaxis, early mobilization, and improved perioperative care have reduced the risk of VTE in surgical patients. However, many patients remain at high risk for VTE because of advanced age, more extensive operative procedures, and greater medical comorbidities.The Institute of Medicine considers failure to provide appropriate VTE prophylaxis to hospitalized, at-risk patients a medical error.The Agency for Healthcare Research and Quality (AHRQ) ranks VTE prophylaxis as among the most important interventions to improve patient safety.1 If used appropriately, prophylaxis is cost effective, as it reduces the incidence of symptomatic thromboembolic events, which require costly diagnostic procedures and prolonged anticoagulation therapy. Venous Thromboembolism (VTE) has an incidence of 1 per 1,000 person-years.1,2  The Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Projects' estimate of incremental inpatient cost are $10,000 per DVT and $20,000 per PE. 1

VTE is one of the three major causes of maternal morbidity and mortality in the United States. For pregnant women, the risk of VTE is 4-5 times higher than for non-pregnant women, and this risk is at least twice as much following Cesarean delivery. Assessing risk and addressing prevention is part of the Maternal Harm Prevention Initiative.3



[1] Agency for Healthcare Research and Quality “Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement” Toolkit @ http://www.ahrq.gov/qual/vtguide/

[2] ”The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism” in Circulation 2009; 119:e480-482 @  http://circ.ahajournals.org/content/119/15/e480.full

[3] Managing Risk and Reducing Readmissions: New Safety Recommendations Prevent Venous Thromboembolism in Maternal Patients by Michael Wong, JD and Lynn Razzano, RN, MSN, ONCC at http://ppahs.files.wordpress.com/2014/01/rmq-fall-2013.pdf



Resources:

AHRQ Preventing Hospital-Acquired Venous Thromboembolism Toolkit

AHRQ "Your Guide to Preventing and Treating Blood Clots" Patient Education Booklet

Society of Hospital Medicine Venous Thromboembolism Resource Room

Institute for Healthcare Improvement (IHI): Venous Thromboembolus (VTE) Prevention & Treatment Institute for Healthcare Improvement (IHI)


HRET Resources:

HRET Venous Thromboembolism (VTE) Change Package 2016
HRET Venous Thromboembolism (VTE) Top Ten Checklist 2016

THA VTE Contact

Jackie Moreland, RN, BSN, MS
Clinical Quality Improvement Specialist
615.401.7439
jmoreland@tha.com

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