Preventing Venous Thromboembolism Across the Surgical Care Continuum

Chapter

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.

Keywords

Deep vein thrombosis Pulmonary embolism Venous thromboembolism Venous thromboembolism prophylaxis Patient safety System of care Public reporting Surveillance bias Process measure Outcome measure 

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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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of SurgeryThe Johns Hopkins HospitalBaltimoreUSA
  2. 2.Department of SurgeryThe Johns Hopkins HospitalBaltimoreUSA

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