Preventability of venous thromboembolism in hospitalised patients

Narayan, Sujita W.; Gad, Fady; Chong, Julianne; Chen, Vivien; Patanwala, Asad E.

doi:10.1111/imj.15600

Cited by 4 publications

(8 citation statements)

References 6 publications

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“…• • Process failures could occur in VTE risk assessment, prescription of appropriate VTE prevention (including mechanical prophylaxis) or the administration of prescribed VTE prophylaxis. Narayan 6 • • VTE occurring in a patient with suboptimal prophylaxis without a contraindication.…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies have reported rates of potentially preventable HA-VTE of 10% to 70%. 2,5,6 The large variation in reported rates is related to the lack of a standardized definition and approach for measuring preventable HA-VTE. Missed doses of a pharmacologic agent for VTE prevention comprised the largest contributing factor for HA-VTE occurring in more than 25% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…2 A consensus definition and approach to measuring potentially preventable HA-VTE currently does not exist, Table 1. [4][5][6][7][8] Lau et al describes effective VTE prevention as a multifactorial, complex process that addresses 4 key stakeholders 4 . Clinicians must ensure appropriate risk assessment is performed, providers must prescribe appropriate therapy considering patient specific factors, patients must accept the therapy and nurses must ensure therapy is administered.…”

Section: Introductionmentioning

confidence: 99%

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Hospital Acquired Venous Thromboembolism: A Preventability Assessment

Smythe,

Koerber,

Roberts

et al. 2023

Hosp Pharm

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Background: The American Heart Association has a call to action to reduce hospital acquired venous thromboembolism (HA-VTE) by 20% by the year 2030. There is increasing recognition that quality improvement initiatives for VTE reduction should focus on reducing potentially preventable HA-VTE. The objective of our study was to determine what proportion of HA-VTE events are potentially preventable. Methods: This was a retrospective, single center pilot study of 50 patients with HA-VTE. Seven preventability factors were identified with a focus on VTE prescription and administration. Data were extracted through chart review using a systematic data collection form. The primary endpoint was the proportion of patients with potentially preventable HA-VTE. Descriptive statistics were used. Results: The median age was 66 years with an admission VTE risk level of moderate-high in 94%. Potentially preventable HA-VTE was found in 40% of cases. Missed doses occurred in 29.8% with a median of 2 missed doses and a range of 1 to 20. Patient refusal was the most common reason for missed doses in 71%. Delays in initiation occurred in 12.7%. Sixty percent of those on mechanical prophylaxis only had nonadherence. Conclusion: Forty percent of HA-VTE cases were potentially preventable. Missed doses was the most common preventability factor identified with patient refusal accounting for most missed doses.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hospital Acquired Venous Thromboembolism: A Preventability Assessment

Smythe,

Koerber,

Roberts

et al. 2023

Hosp Pharm

View full text Add to dashboard Cite

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“…Our internal data suggest each episode of HA‐VTE costs the institution approximately AU$4000–AU$7000. However, centres with higher rates of trauma and surgery would be expected to report higher rates of HA‐VTE, with only a small proportion of these considered truly preventable 4 . These events are identified through the International Classification of Diseases 10th edition (ICD‐10) coding from hospital discharge summaries, which are known to be of variable accuracy 5 .…”

Section: Figurementioning

confidence: 99%

“…However, centres with higher rates of trauma and surgery would be expected to report higher rates of HA-VTE, with only a small proportion of these considered truly preventable. 4 These events are identified through the International Classification of Diseases 10th edition (ICD-10) coding from hospital discharge summaries, which are known to be of variable accuracy. 5 Penalising institutions purely on a figure extracted from hospital coding ignores the complexity of balancing bleeding and VTE risk in this patient cohort and may discriminate against centres with high surgical caseload rather than providing an accurate representation of VTE risk assessment and prevention.…”

mentioning

confidence: 99%

High rate of false‐positive postoperative venous thromboembolism identified using hospital ICD‐10 coding

Bortz

Shi

Chee

et al. 2023

Internal Medicine Journal

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The Health Roundtable, a national benchmarking body, identified our institution as an outlier with a high number of postoperative venous thromboembolism (VTE) events. We performed a retrospective study to determine the accuracy of hospital coding for the incidence and severity of postoperative VTE. Of 232 patients identified from ICD-10 coding, 52 (22.4%) were incorrectly coded. Approximately one third (n = 68) of all VTE were asymptomatic, diagnosed incidentally. Thus, coding data are inherently flawed with inaccuracy and overrepresent the true number of VTE events, with a substantial proportion of limited clinical relevance.

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The Portuguese Public Hospitals Performance Evolution before and during the SARS-CoV-2 Pandemic (2017–2022)

Caldas

Varela

2023

Sustainability

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COVID-19 is a disease caused by SARS-CoV-2, which has spread worldwide since the beginning of 2020. Several pharmaceutical and non-pharmaceutical strategies were proposed to contain the virus, including vaccination and lockdowns. One of the consequences of the pandemic was the denial or delay of access to convenient healthcare services, but also potentially the increase in adverse events within those services, like the number of hospital infections. Therefore, the main question here is about what happened to the performance of Portuguese public hospitals. The main goal of this work was to test if the Portuguese public hospitals’ performance has been affected by the SARS-CoV-2 pandemic. We used the Benefit-of-Doubt method integrated with the Malmquist Index to analyze the performance evolution over time. Then, we employed a multiple regression model to test whether some pandemic-related variables could explain the performance results. We considered a database of 40 Portuguese public hospitals evaluated from January 2017 to May 2022. The period 2017 to 2019 corresponds to the baseline (pre-pandemic), against which the remaining period will be compared (during the pandemic). We also considered fourteen variables characterizing hospital quality, divided into three main performance definitions (efficiency and productivity; access; safety and care appropriateness). As potential explanatory variables, we consider seven dimensions, including vaccination rate and the need for intensive care for COVID-19-infected people. The results suggest that COVID-19 pandemic features help explain the drop in access after 2020, but not the evolution of safety and appropriateness of care, which surprisingly increased the whole time.

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Preventability of venous thromboembolism in hospitalised patients

Cited by 4 publications

References 6 publications

Hospital Acquired Venous Thromboembolism: A Preventability Assessment

Hospital Acquired Venous Thromboembolism: A Preventability Assessment

High rate of false‐positive postoperative venous thromboembolism identified using hospital ICD‐10 coding

The Portuguese Public Hospitals Performance Evolution before and during the SARS-CoV-2 Pandemic (2017–2022)

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