Venous Thromboembolism (VTE), a condition in which blood clots form (most often) in the deep veins of the leg (known as deep vein thrombosis, DVT) and can travel in the circulation and lodge in the lungs (known as pulmonary embolism, PE), is categorized by the U.S. Surgeon General as a major public health problem. Hospitalized patients are at an increased VTE risk, and the use of appropriate prophylaxis, chemical and/or mechanical, can reduce this.
VTE is relatively common and associated with reduced survival, substantial health-care costs, and frequent re-occurrence. However, many prevention efforts fail due to lack of standardized guidance integrated at the point of care, or due to flawed risk assessment models that either offer no guidance or are so complicated that providers bypass them.
Proper assessment of VTE risk level in hospitalized patients is vital to providing timely preventive treatment. When used consistently, EMR-embedded clinical decision support tools can improve timely patient assessment and VTE prophylaxis.
What is Venous Thromboemolism (VTE)?
- A blood clot that starts in a vein
- 3rd leading vascular diagnosis after heart attack and stroke
- Affects 300K – 600K Americans annually
Types of VTE
- Deep Vein Thrombosis (DVT) is a clot in a deep vein, usually leg
- Pulmonary Embolism occurs when a DVT clot breaks free from a vein wall and travels to the lungs and blocks some or all of the blood supply
- Slowing or changes in blood flow
- Surgery – major, general, orthopedic
- Pregnancy or hormones
Those at High Risk
- Cancer/autoimmune disorders
- Genetic causes of excessive blood clotting
Incidence & Complications
- 50%+ of hospital-acquired VTE are preventable.
10% of VTE events can result in fatal pulmonary embolus, the most common preventable cause of hospital death.
- VTE is a significant cause of hospital readmissions after surgery
Best Practices for Prevention
- Mandatory risk assessment & reassessment during hospital stay (using embedded clinical decision support)
- Sequential Compression Devices (SCDs)
- Anticoagulant prophylactic therapy
- Early and frequent ambulation and activity
- Patient Education
The AHRQ best practice document states that to achieve over 90% VTE compliance, the EMR protocol should recommend prophylaxis or require contraindications based on a patient’s risk level. In addition, indirectly increasing compliance for VTE/DVT/PE has a significant impact on readmission, morbidity, and mortality rates.
Valley Health, the gold standard for care in the New York/New Jersey area serving over 440,000 people in Bergen county and the surrounding communities, recently addressed increased VTE complications through deployment of ENGINUITY, embedded clinical decision support for MEDITECH 6.X/6.1+/EXPANSE. Valley was having trouble with their VTE Prophylaxis compliance rates, dropping sharply from 96% to 79% in just 6 months post-implementation of MEDITECH’s newest platform in 2015. Moving from MEDITECH MAGIC to 6.1 allowed Valley to access more modules and functionality, but the conversion left behind years of perfected custom attribute code that Valley used to drive compliance protocols facility wide.
Valley Health went LIVE with the ENGINUITY VTE Prophylaxis Compliance protocol in November of 2018, and in just three months post implementation, compliance was at 94% and on the rise. This is the highest compliance rate Valley has seen since 2015.