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Preventing Venous Thromboembolism Across the Surgical Care Continuum

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Abstract

Prevention of venous thromboembolism (VTE) is a critical patient safety practice as well as an important measure of healthcare quality. Evidence-based guidelines for VTE prevention are available and strongly encouraged for adoption, but studies continue to show that hospitalized patients are not routinely provided with risk-appropriate VTE prophylaxis. The American Public Health Association (APHA) has suggested that the disconnect between evidence and implementation of VTE prophylaxis amounts to a public health crisis. Some groups consider VTE a “never event” and national and regional bodies impose financial penalties when hospitalized patients develop VTE. However, it is important to recognize that some VTE events are not truly preventable, even with current best-practice prophylaxis. A true benchmark of patient safety and quality care should not only focus on the incidence of VTE (outcome measure) but also consider how frequently patients are prescribed and administered VTE prophylaxis according to best-practice guidelines (process measure). This chapter will review VTE incidence, risk factors, and specific prevention strategies but will primarily focus on VTE as an example of how to improve healthcare quality and patient safety through active interventions within the system of care. Diagnosis approaches and treatment algorithms are widely published elsewhere, and an exhaustive review is beyond the intended scope of this chapter.

“The disconnect between evidence and execution as it relates to DVT prevention amounts to a public health crisis.”

—American Public Health Association

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Abbreviations

AAOS:

The American Academy of Orthopedic Surgeons

ACCP:

The American College of Chest Physicians

AHRQ:

The Agency for Healthcare Research and Quality

APHA:

The American Public Health Association

CDS:

Clinical decision support

CPOE:

Computerized provider order entry

DVT:

Deep vein thrombosis

EAST:

The Eastern Association for the Surgery of Trauma

INR:

International normalized ratio

IVC:

Inferior vena cava

LMWH:

Low molecular weight heparin

PCORI:

Patient-Centered Outcomes Research Institute

PE:

Pulmonary embolism

SC:

Subcutaneous

SCDS:

Sequential compression devices

TEDS:

Thromboembolic deterrent stockings

US:

United States

V/Q:

Ventilation/perfusion scan

VTE:

Venous thromboembolism

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Author information

Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Tower 110, Baltimore, MD, 21287, USA

    Lisa M. Kodadek MD

  2. Department of Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower, Suite 6107C, Baltimore, MD, 21287, USA

    Elliott R. Haut MD, PhD, FACS

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  1. Lisa M. Kodadek MD
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  2. Elliott R. Haut MD, PhD, FACS
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Correspondence to Elliott R. Haut MD, PhD, FACS .

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Editors and Affiliations

  1. Department of Surgery Ascension Saint Agnes Hospital Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Juan A. Sanchez

  2. Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research Scholar, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA

    Paul Barach

  3. Department of Surgery Center for Healthcare Studies Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Julie K. Johnson

  4. Division of Cardiovascular Surgery Johns Hopkins All Children’s Heart Institute Johns Hopkins All Children’s Hospital, Johns Hopkins University, Saint Petersburg, FL, USA

    Jeffrey P. Jacobs

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Kodadek, L.M., Haut, E.R. (2017). Preventing Venous Thromboembolism Across the Surgical Care Continuum. In: Sanchez, J., Barach, P., Johnson, J., Jacobs, J. (eds) Surgical Patient Care. Springer, Cham. https://doi.org/10.1007/978-3-319-44010-1_29

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