Most hospital patients have at least one of these VTE risk factors, which are sorted into three categories:
- Stasis: conditions such as advanced age, immobility, paralysis, or stroke;
- Hypercoaguability: smoking, pregnancy, cancer, or sepsis; and
- Endothelial damage: surgery, prior VTE, central lines, or trauma.
Because the potential VTE risk is so high in hospital patients, the assessment must go hand in hand with prophylaxis, says Dr. Maynard and other hospitalists working with VTE.
Recent research has shown that prescribing medications to prevent VTE before it begins is safe, effective, and cost-effective.
The Hospitalist’s Role
Ray Grover/Alamy
One of the goals of SHM’s VTE Prevention Collaborative is to get physicians to order a shot in the abdomen once per day for hospitalized VTE patients.
The responsibility for VTE risk assessment and prevention often falls to hospitalists. In its online VTE Resource Room, SHM provides information for hospitalists working to assess and prevent VTE in their patients. It also provides a complete toolkit for hospitalists interested in addressing VTE prevention systematically throughout their hospitals. The toolkit is part of a comprehensive VTE Prevention Collaborative, which provides real-world mentoring and materials to hospitalists as they develop VTE monitoring and prevention programs.
“In 2005, when SHM set up the Quality Improvement resource room, we began with VTE prophylaxis,” Dr. Stein says. “VTE is the No. 1 cause of preventable death in hospitals, and preventing it is a fundamentally simple thing for hospitalists to do. We’re trying to get physicians to order a shot in the abdomen once a day. … If we can’t do that, we’re in trouble. On the flipside, if we can figure that out, we can derive mechanisms that we can apply to more complex problems in care.”
Together with SHM, Drs. Stein and Maynard have pioneered a two-pronged approach known as “measure-vention.” The underlying principal of measure-vention is that monitoring for VTE risk in real time can empower hospital staff to remedy issues in real time. In most hospitals, VTE risk can only be measured retrospectively through quality improvement data, which can take months to collect.