Preventing Venous Thromboembolism Across the Surgical Care Continuum
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.
KeywordsDeep vein thrombosis Pulmonary embolism Venous thromboembolism Venous thromboembolism prophylaxis Patient safety System of care Public reporting Surveillance bias Process measure Outcome measure
The American Academy of Orthopedic Surgeons
The American College of Chest Physicians
The Agency for Healthcare Research and Quality
The American Public Health Association
Clinical decision support
Computerized provider order entry
Deep vein thrombosis
The Eastern Association for the Surgery of Trauma
International normalized ratio
Inferior vena cava
Low molecular weight heparin
Patient-Centered Outcomes Research Institute
Sequential compression devices
Thromboembolic deterrent stockings
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