Hospitalization for acute medical illness is associated with an increased risk of venous thromboembolism (VTE). While pharmacologic prophylaxis has been shown to reduce the incidence of VTE, rates of prophylaxis are low in many U.S. hospitals. There have been numerous efforts to increase prophylaxis use in hospitalized patients, but the ability to evaluate the effect on hospital‐associated VTE in medical patients has been limited by studies including heterogeneous patient populations or single site designs. We sought to evaluate the effect of increasing rates of pharmacologic prophylaxis on hospital‐associated VTE in medical patients in a diverse group of hospitals in Michigan.
The Michigan Hospital Medicine Safety Consortium is a quality collaborative of 40 hospitals with a goal of preventing adverse events in hospitalized medical patients. Using web‐based data entry, a trained nurse abstractor at each hospital collects detailed demographic and clinical data, including all known risk factors for VTE, use of pharmacologic prophylaxis, and VTE events out to 90 days after discharge for 760 patients annually. For this analysis, patients < 18 years of age or with length of stay < 1 day, obstetric or surgical patients, patients with contraindications to prophylaxis, patients on systemic anticoagulation, patients not at risk for VTE, and patients admitted directly to the ICU were excluded. At risk for VTE was defined as a Caprini score >= 2. VTE outcomes were determined by medical record review and follow‐up phone calls and included all proximal upper and lower extremity DVT and PE. Annual audits of all hospitals included a review of all VTE events and an additional random case sample.
Sixteen hospitals began data collection in quarter 1, 2011, and by quarter 2, 2013, 40 hospitals were participating. Over the 2.5 years included in this analysis, data on 52,989 patients were fully abstracted. A total of 35,040 patients met inclusion criteria. The mean age was 66 years (SD 17.6), mean Caprini score was 5.6 (SD 2.4), and the median length of stay was 4 days (IQR 3,5) and did not change over time. The rate of pharmacologic prophylaxis ordered on admission increased by 29% from an average of 59.2% to 76.4% (p<0.001 for trend). The overall rate of VTE through 90 days after discharge averaged 0.56% and did not change over time (p=0.114 for trend. See figure.)
The overall rate of VTE at 90 days in hospitalized medical patients is very low, and significantly increasing rates of pharmacologic prophylaxis were not associated with reductions in VTE. Quality improvement efforts should focus on identifying patients at higher risk of VTE who would benefit from pharmacologic prophylaxis, as well as those at lower risk for VTE who may not need prophylaxis.
To cite this abstract:Flanders S, Greene M, Kaatz S, Grant P, Paje D, Lee B, Barron J, Wietzke J, Bernstein S. The Impact of Increasing Pharmacologic Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients: Results from the Michigan Hospital Medicine Safety Consortium. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 107. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/the-impact-of-increasing-pharmacologic-venous-thromboembolism-prophylaxis-in-hospitalized-medical-patients-results-from-the-michigan-hospital-medicine-safety-consortium/. Accessed November 22, 2019.