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Impact of a Mandatory Venous Thromboembolism (VTE) Prevention Program on Rates of Prophylaxis and Hospital Acquired Pulmonary Embolism (PE)
Elizabeth S. Levin, Reid Ravin, Lisa Mainieri, Eliot J. Lazar, MD, Robert A. Green, MD, Nicholas J. Morrissey, MD.
Columbia University, New York, NY, USA.
Objective
The use of a hospital wide electronic risk assessment tool was hypothesized to improve rates of appropriate venous thromboembolism (VTE) prophylaxis and decrease the rate of hospital acquired pulmonary embolism (PE).
Methods
Beginning June 2010, all patients admitted to a 2300 bed academic hospital had VTE risk and prophylaxis assessed as part of their admission orders. A retrospective review identified 127 patients between January 2010 and March 2011 who developed hospital acquired PE. Positive events were identified via conclusive imaging with CT angiogram in all cases. Patient demographics, clinical details, diagnostic modalities, and hospital course data were collected. Descriptive statistics and chi-square tests were used to describe data and compare variables (alpha= p < 0.05). Tool implementation occurred midway through 2010. Additional detailed examination of in-hospital VTE prophylactic measures was performed to determine the effects of tool implementation on rates of appropriate DVT prophylaxis.
Results
127 PE occurred between January 2010 and March 2011, with a significant decrease noted after implementation of the VTE prevention tool (table 1). Absolute risk reduction with tool use was 13%, with relative risk reduction of 39%. Based on review of all patients with documented PE, implementation of a mandatory VTE prevention program dramatically increased the proportion of patients who were on appropriate prophylaxis when they suffered an event.
Conclusions
Implementation of an electronic tool that addressed the VTE risk and provided an appropriate order set for all patients on admission significantly decreased the occurrence of hospital acquired PE and improved the rate of patients on appropriate prophylactic therapy for VTE. Future efforts are directed at the use of electronic order and alert systems to assure the level of appropriate prophylaxis approaches 100% and allows real time adjustment of prophylactic therapy to optimize patient care.
Table 1 | PE Rate per 1000 patient days | Proportion of PE occurring with appropriate ppx | | Pre implementation of Tool | .33 | .35 | | Post Implementation of Tool | .20 | .77 | | P Value | <.0001 | <.0001 |
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