Know Risk for VTE
Know what the literature says about risk for VTE
The team will need to rely on at least one content expert to bring fluency with the evidence base and best practice for preventing HA-VTE. Especially relevant or authoritative are the published performance measures from the Joint Commission and guidelines from the American College of Chest of Physician’s conference on Antithrombotic and Thrombolytic Therapy. We recommend supplementing that consensus statement as needed with the reading list in the “Literature Review” section of the Society of Hospital Medicine’s VTE Quality Improvement Resource Room. At least three central realities emerge from the current VTE prevention literature, each with important implications for the team.
Reality #1: While the number and type of VTE risk factors appear to influence a patient’s overall VTE risk, there is no validated method to predict accurately or efficiently an individual patient’s risk for VTE.
Meanwhile, in the absence of prophylaxis, the risk of VTE across almost all populations of hospitalized patients is significant.
The 7th ACCP Conference statement supports a group-specific approach to prophylaxis, the reasons for which are outlined below. 10
- inability to confidently identify patients who do not require prophylaxis
- inability to predict how risk factors combine to position an individual patient along the spectrum of thromboembolic risk
- individualizing prophylaxis is logistically complex and likely associated with suboptimal compliance
In real terms, we favor constructing simple risk assessment models that stratify all patients into 3-4 easy to understand groups, as opposed to more complicated point scoring systems. The concept of the “VTE protocol” and suggestions for keeping it simple and effective are discussed later in Reliable Interventions.
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