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VTE core measures

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Justin Boccardo

on 6 February 2013

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Transcript of VTE core measures

Venous Thromboembolic Events Is your patient at risk? Say What?! Activity Overview Justin Boccardo, MD, FACS Help clinicians with in-patient care
Translate current evidence into strategies that can improve outcomes of venous thromboembolic events (VTE) in those patients.
Accurately identify and assess patients at risk of VTE
Implement guideline-recommended measures as mandated prophylaxis strategies. THE “FACTS" Are...
2,000 deaths/year from unnecessary surgery
7,000 deaths/year from medication errors in hospitals
20,000 deaths/year from other errors in hospitals
80,000 deaths/year from nosocomial infections in hospitals
106,000 deaths/year from non-error, adverse effects of medications
Total up to 225,000 deaths/year in the US from iatrogenic causes
Well above motor vehicle accidents and violent crime. Hospitalized patients are at high risk for venous thromboembolism (VTE).
2 million Americans suffer from VTE each year, over half of these in the hospital or in the 30 days post hospitalization.
Fewer than 5 percent of medical patients could be considered at low risk by most VTE risk stratification methods.
Medical patients probably account for more than half of all hospital-acquired VTE events.
Without prophylaxis DVT risk is
10 to 26% in general medical patients
17 to 34% in patients with myocardial infarction
20 to 40% in patients with congestive heart failure
11 to 75% in patients with stroke
400-bed hospital with average prevalence of VTE prophylaxis can expect
200 patients will suffer from hospital-acquired VTE each year VTE reduction is a priority of The Joint Commission (TJC) and the Centers for Medicare & Medicaid Services (CMS).
VTE is the #1 cause of potentially preventable deaths in hospitalized patients.
VTE prophylaxis is rated by AHRQ as the #1 most effective patient safety practice for hospitals.
VTE prophylaxis rates are publicly reported on the Hospital Compare Web site.
CMS no longer pays hospitals for the additional costs incurred for treatment of hospital-acquired VTE in selected patients. Heit JA, O’Fallon WM, Petterson TM, Lohse CM, Silverstein MD, Nohr DN, & Melton, LJ. (2002). Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: A population-based study. Arch Intern Med, 162:1245–1248.
Hirsh J, & Hoak J. (1996). Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation, 93:2212–2245.
National Heart, Lung, and Blood Institute. What Is Deep Vein Thrombosis? Available at http://www.nhlbi.nih.gov/health/dci/Diseases/ Dvt/DVT_WhatIs.html. Accessed March 5, 2008
Stinnett JM, Pendeleton R, Skordos L, Wheeler M, & Rogers GM. (2005).Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates. Am J Hematol, 78:167–172. References American College of Chest Physicians: www.chestnet.org
American Medical Directors Association—DVT Clinical Corners: www.amda.com/tools/clinical/dvt.cfm
American Venous Forum: www.venous-info.com
Case Management Adherence Guidelines for VTE: www.cmsa.org/portals/0/pdf/CMAG_DVT.pdf
Coalition to Prevent DVT: www.preventDVT.org
Consumers Advancing Patient Safety: www.patientsafety.org
Society of Hospital Medicine—VTE Prevention Collaborative: www.hospitalmedicine.org
Translating VTE Guidelines Into Practice: http://www.hsag.com/services/special/vte.aspx
Vascular Disease Foundation: www.vdf.org
Venous Resource Center: www.venousdisease.com Resources Process Measures
67.50% N=27|D=40. (VTE-1)
100.00% N=2|D=2). (VTE-2)
21.05% N=4|D=19. (VTE-5) VTE1—Proportion of patients who received VTE prophylaxis or have documentation why no prophylaxis was given within the first 24 hours of hospitalization hospital days (Med/Surg patients who have a 48h stay).
VTE2—Proportion of patients who received VTE prophylaxis or have documentation why no prophylaxis was given within the first two hospital days (ICU patients).
VTE3—Patients treated with parenteral anticoagulant and warfarin who have at least 5 days of overlap therapy with an INR > 2.0 prior to discontinuation of parenteral treatment (or who are discharged before 5 days on overlap therapy) VTE4—Proportion of patients treated with UFH who have dose managed by nomogram/protocol that includes explicit count monitoring protocols (baseline, day after initiation, and at least three times per week for up to 14 days)
VTE5—Proportion of patients discharged from the hospital on warfarin with documentation of discharge instructions addressing compliance, dietary restrictions, follow-up monitoring, and adverse drug reactions/interactions.
VTE6—Proportion of patients with hospital-acquired VTE who received no prophylaxis prior to the event. Venous thromboembolism leads to substantial inpatient costs, morbidity, and mortality.
200,000 patient deaths represent more annual deaths than those from breast cancer, AIDS, and traffic accidents combined.
PE is the most common preventable cause of death in the hospital, 10 percent of inpatient deaths are secondary to PE.
Patients who survive the initial diagnosis of PE face a mortality rate of 17.5 percent at 90 days.
The Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Projects' estimates incremental inpatient cost are $10,000 per DVT and $20,000 per PE.
The Centers for Medicare & Medicaid Services is currently considering the inclusion of hospital-acquired DVT and PE in its list of events for which hospitals will no longer be reimbursed.

Effective, safe, and cost-effective measures to prevent hospital-acquired VTE exist.
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