According to the guidelines of the American Society of Chest Physicians, medical, and surgical oncology patients continue to be at increased risk for venous thromboembolic events (VTE). Undiagnosed and untreated pulmonary embolism is a major cause of hospital acquired death. Hospitalists have begun to assume primary responsibility of these patients or serve to comanage them. We sought to look at ways in which the HospitalistOncologist CoManagement model might benefit clinical patient outcomes. HospitalistPharmacist Collaborations have been described in the literature to improve clinical outcomes.
In July 2006, the University of Miami’s Sylvester Comprehensive Cancer Center began a hospitalist program designed to comanage medical oncology and hematology patients admitted to the facility. Our internal needs assessment revealed inconsistent practice patterns for VTE prophylaxis. In 2007, we convened a HospitalistPharmacist Collaborative to improve adherence to evidencebased practice for VTE prophylaxis and improve process measures and patient outcomes.
IRB approval was obtained. In calendar year 2006 (preintervention) there were 10.16 cases of hospital acquired VTE per 100 admissions (cases per 100). A standard VTE prophylaxis order set was implemented for all hospitalist patients in the summer of 2007. In 2007, there were 5.63 cases per 100. In the summer of 2008, the use of the VTE prophylaxis order set was expanded to surgical oncology patients. In 2008, there were 9.18 cases per 100. In 2009, there were 2.14 cases per 100. In 2010, there were 1.62 cases per 100. Preliminary data on 2011 follow recent trends. Furthermore, we have seen an improvement in secondary measures associated with highquality VTE programs: (1) VTE protocol completed within 48 h of admission, baseline labs reports, monitoring of continuous labs, documentation of therapeutic and adverse effects of anticoagulation, and documentation of patient and family education on anticoagulant therapy. Over 5 years, compared to baseline, we have prevented more than 42 VTE events and noncancer related deaths in these highrisk patients. Furthermore, we estimate we have saved the institution $ 420,000840,000 in costs associated with caring for hospital acquired VTE.
As hospitalists play increasing roles in patient care at specialty hospitals like cancer centers, creating care pathways is another mechanism of benefit of hospitalist with clinical patient outcomes.
To cite this abstract:Manjarrez E, EyminLago G, Douglas L. Hospitalistpharmacist Collaborative at a Regional Cancer Center Decreases Hospital Acquired Vte Events. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97570. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/hospitalistpharmacist-collaborative-at-a-regional-cancer-center-decreases-hospital-acquired-vte-events/. Accessed May 26, 2019.