Venous Thromboembolism Rates in Transferred Patients: A Cross-Sectional Study.

BACKGROUND: Patients undergoing a transfer during a hospitalization may be more likely to be diagnosed with a venous thromboembolism (VTE) than patients who are not transferred. OBJECTIVE: To determine whether transferred patients have an increased prevalence of VTE diagnosis. DESIGN: This was a cross-sectional study comparing VTE diagnosis rates between transferred patients and non-transferred patients. For the years 2012-2014, the University HealthSystem Consortium database of multiple community and academic medical centers throughout the United States was parsed using ICD-9 VTE diagnosis codes and patient's point of origin. PATIENTS: Patients were included in the analysis as transferred patients if their point of origin was a skilled nursing facility, another acute care facility or another facility. Non-transferred patients were those whose point of origin was a clinic or those with a non-facility point of origin. MAIN MEASURES: The primary comparison of VTE prevalence during hospitalization between transferred and non-transferred patients in the years 2012-2014. Subgroup analysis looked at level I trauma status and case mix index (CMI) to determine whether these had an effect on VTE prevalence. KEY RESULTS: From 2012 to 2014, a total of 225 unique hospitals and 12,036,029 patients were analyzed, and the prevalence of VTE in transferred patients and non-transferred patients was 3.43% and 1.91% (RR 1.80; 95% CI 1.78-1.81; P <0.001), respectively. VTE prevalence in transferred versus non-transferred patients at level I trauma centers was 3.42% versus 1.88% (RR = 1.82; 95% CI 1.80-1.85; P <0.001). The 3-year average CMI of transferred versus non-transferred patients was 3.53 versus 2.26 (P < 0.001). CONCLUSIONS: Transferred patients have a higher prevalence of VTE than non-transferred patients, regardless of level I trauma designation. Higher VTE rates in transferred versus non-transferred patients was minimally correlated with CMI.

Implementation of a mandated venous thromboembolism clinical order set improves venous thromboembolism core measures.

BACKGROUND: Venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, is a major cause of morbidity and mortality. It results in approximately 300 000 deaths in the United States each year, and two thirds of VTE events are hospital acquired. However, VTE prophylaxis for hospitalized patients remains suboptimal. OBJECTIVES: Assess the effect of a physician-mandated VTE prophylaxis computerized order set on the rates of hospital acquired VTE. METHODS: A retrospective prevalence study of hospitalized patients pre- and postimplementation of a mandatory VTE order set. Additionally, the Joint Commission VTE Core Measures data was tracked for improvements postimplementation. RESULTS: At baseline, 73% of patients received appropriate prophylaxis (n = 148) compared with 90% (n = 192) postintervention (P = 0.015). The percentage of patients who received VTE prophylaxis within 24 hours of arrival at the hospital increased from a baseline of 73% to 93% postimplementation (P = 0.0004). Hospital-acquired VTE prevalence rates decreased from 2% (4 cases) to 0.05% (1 case; P = 0.37) post intervention. The incidence of potentially preventable VTE cases (the Joint Commission's core measure 6) decreased from 3.9% to 0% (P = 0.39). These differences were not statistically significant, but they are clinically significant. These results were also sustained over time. CONCLUSION: This study demonstrates that a mandated physician VTE order set ensures that nearly all patients will be stratified for VTE risk and provided with prophylaxis based on their risk category. Adhering to the evidence-based clinical practice guidelines from the American College of Chest Physicians is effective in improving prophylaxis and decreasing the rate of hospital-acquired VTE in hospitalized patients, and in decreasing the rate of preventable VTE cases based on the Joint Commission's core measure 6.