Missed Doses of Venous Thromboembolism (VTE) Prophylaxis at Community Hospitals: Cause for Alarm
Venous thromboembolism (VTE) is a leading cause of potentially preventable harm. Randomized controlled trials have demonstrated that VTE prophylaxis, when administered completely, significantly reduces the risk for deep vein thrombosis, pulmonary embolism (PE), and fatal PE.1
Numerous interventions have been successful in improving the prescription of VTE prophylaxis.2 Unfortunately, few interventions have ensured that prescribed VTE prophylaxis is actually administered. One study from a large academic hospital reported that 10% of VTE prophylaxis doses were not administered.3 A larger study in another academic hospital found that 12% of VTE prophylaxis doses were not administered, where 40.6% of all hospitalized patients and 46.2% of all medically ill patients missed ≥1 dose.4
This small but growing body of evidence has come entirely from academic hospitals, and thus provides no insight into practice at community hospitals, which account for the vast majority of hospitals...
KEY WORDSvenous thromboembolism quality improvement safety
We would like to thank Ann Hoffman, MBA, and Shamil Fayzullin for their assistance in obtaining medication administration data.
This project was supported by contract CE-12-11-4489 “Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology” from The Patient-Centered Outcomes Research Institute (PCORI).
Compliance with Ethical Standards
Conflict of Interest
Mr. Lau and Drs. Streiff and Haut are supported by a grant from the AHRQ (1R01HS024547) entitled “Individualized Performance Feedback on Venous Thromboembolism Prevention Practice,” a contract from PCORI entitled “Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis,” and a grant from the NIH/NHLBI (R21HL129028) entitled “Analysis of the Impact of Missed Doses of Venous Thromboembolism Prophylaxis.” Mr. Lau is supported by the Institute for Excellence in Education Berkheimer Faculty Education Scholar Grant and a contract (AD-1306-03980) from the Patient-Centered Outcomes Research Institute (PCORI) entitled “Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the Emergency Department.” Ms. Hobson has given expert witness testimony in various medical malpractice cases. Dr. Pronovost reports consultancy fees from the Association for Professionals in Infection Control and Epidemiology, Inc.; grant or contract support from the Agency for Healthcare Research & Quality, National Institutes of Health, Robert Wood Johnson Foundation, Patient-Centered Outcomes Research Institute, and The Commonwealth Fund; honoraria from various hospitals and the Leigh Bureau (Somerville, NJ); and royalties from his book, Safe Patients, Smart Hospitals. Dr. Streiff has received research funding from Portola and Janssen, consulted for Bio2 Medical, CSL Behring, Merck and Janssen Healthcare, and has given expert witness testimony in various medical malpractice cases. Dr. Haut is a paid consultant and speaker for the “Preventing Avoidable Venous Thromboembolism—Every Patient, Every Time” VHA/Vizient IMPERATIV® Advantage Performance Improvement Collaborative. Dr. Haut receives royalties from Lippincott, Williams & Wilkins for the book Avoiding Common ICU Errors. Dr. Haut is a paid consultant and speaker for the Illinois Surgical Quality Improvement Collaborative (ISQIC). Dr. Haut was the paid author of a paper commissioned by the National Academies of Medicine titled “Military Trauma Care’s Learning Health System: The Importance of Data Driven Decision Making,” which was used to support the report titled A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. All other authors declare that they have no conflict of interest.