Hospitalassociated venous thromboembolism (VTE) is estimated to affect up to 15% of hospitalized general medical patients and is believed to be the most preventable cause of death in the hospital. Pharmacologic prophylaxis reduces the rate of VTE and, as a result, the Agency for Healthcare Research and Quality lists VTE prophylaxis as the “number one patient safety practice” and The Joint Commission has added VTE prophylaxis as an optional core measure. Despite its efficacy, several studies suggest that VTE prophylaxis is administered in only 1545% of atrisk medical patients. To address this gap, the Michigan Hospital Medicine Safety Consortium (HMS), a multihospital quality collaborative designed to prevent adverse events in hospitalized medical patients, began an initiative focused on improving rates of VTE prophylaxis. In this analysis, we examine baseline variation in VTE risk assessment.
We applied the VTE risk assessment tools used by 10 HMS hospitals to the admission note of 100 patients hospitalized at the University of Michigan and classified pharmacologic prophylaxis recommendations for each patient as: recommended, optional, or not recommended. Two published VTE risk assessment tools were used as gold standards for the assignment of risk: the Caprini scoring system and the American College of Chest Physician’s (ACCP) VTE prophylaxis guidelines.
Each hospital had its own unique risk tool, but all used risk categories ranging from low to highest risk. One tool utilized two categories of risk, seven had three categories, and two had four categories. All 10 hospitals recommended pharmacologic prophylaxis for high and highest risk patients, but treatment recommendations varied for moderate and low risk patients. Only 16 patients were assigned to the same risk category by all 10 hospitals. Of the 91 patients for whom VTE prophylaxis was recommended by both the Caprini and ACCP risk tools, only 36 patients were recommended to receive prophylaxis by all hospitals. Using a Caprini score >= 2 as warranting prophylaxis, agreement with that recommendation varied between 100 and 40% (chart) across hospitals. The results did not differ when using ACCP guidelines as the gold standard.
Assignment of VTE risk varies significantly between hospitals and likely contributes to differing rates of prophylaxis. National efforts to improve prophylaxis rates would be facilitated by better defining risk factors, standardizing risk assessment, and clarifying prophylaxis recommendations for different levels of risk.
To cite this abstract:Wietzke J, Cowan K, Greene M, Grant P, Flanders S, Kaatz S, Bernstein S. Variability in the Assignment of Venous Thromboembolism Risk and Pharmacologic Prophylaxis Recommendations for Hospitalized Medical Patients: Lessons from a Multihospital Quality Collaborative. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97605. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/variability-in-the-assignment-of-venous-thromboembolism-risk-and-pharmacologic-prophylaxis-recommendations-for-hospitalized-medical-patients-lessons-from-a-multihospital-quality-collaborative/. Accessed July 22, 2019.