By Scott C. Woller, MD, Chair of Medicine, Intermountain Medical Center, Intermountain Healthcare, and Professor of Medicine, University of Utah School of Medicine
Each year in the U.S., it is estimated that venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), affects as many as 900,000 people and is responsible for up to 100,000 deaths. Additionally, VTE is associated with health care costs of approximately $10 billion annually1.
Hospital-associated venous thromboembolism (HA-VTE) has historically been described as occurring in as many as 15% of hospitalized medical patients, and contemporary evidence suggest that clinically overt thrombosis complicates between 0.3 and 9.7% of hospitalizations 2,3. Recently, terrific strides have been taken to understand prognostic factors associated with HA-VTE and just as importantly, bleeding risk4,5. Yet it is estimated that only about 40% of hospitalized medical patients at high risk for VTE receive appropriate thromboprophylaxis6,7. Recent advances report the validation of existing VTE Risk assessment models—RAMs 8,9 and the benefit associated with standardized RAM implementation 3,10. Increasingly best practice to protect patients from HA-VTE may include tailored thrombosis risk mitigation selectively prescribed at hospital discharge 11,12.
However, to optimize VTE risk mitigation, a comprehensive understanding of hospital and healthcare-system VTE prevention practices (including VTE risk assessment) must occur, and this represents an unmet need. It is for this reason that the Centers for Disease Control and Prevention (CDC) Division of Blood Disorders and The Joint Commission will launch this important initiative to provide an accurate snapshot of current activities in U.S. hospitals.
Survey content will explore:
- hospital-level VTE prevention practices
- VTE prevention practices for medical and surgical units
- VTE risk assessment and prophylaxis surveillance
- VTE prevention activities, data collection and reporting
Current Practices Questionnaire
The Joint Commission will be implementing a questionnaire on behalf of the CDC to evaluate current hospital VTE prevention practices in the United States. The information collected in this hospital survey will be used to inform interventions to reduce the burden of hospital-associated VTE (HA-VTE).
An invitation to participate will be sent to a randomly selected sample of 1,290 medical/surgical hospitals across the country. Participation is unrelated to accreditation. The sample includes Joint Commission - accredited hospitals as well as hospitals that are accredited by other organizations or not accredited.
Who Will Receive the Questionnaire?
An email will be sent to the Quality and Safety Director or Chief Medical Officer for hospitals in the sample. The preferred person to complete the questionnaire is the person(s) closest to VTE prevention activities.
If your hospital receives this questionnaire, please complete it promptly. Your input is highly valued and the best way to learn what hospitals are doing to prevent VTE.
Thank you in advance, for your attention to this important questionnaire. With your collaboration by competing this survey, we can together learn how to best proceed with the objective of eliminating preventable venous thromboembolism.
1. Centers for Disease Control and Prevention. Learn about healthcare-associated venous thromboembolism. What is healthcare-associated venous thromboembolism? https://www.cdc.gov/ncbddd/dvt/ha-vte.html. Accessed: August 10, 2021.
2. Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, De Bon E, Tormene D, Pagnan A, Prandoni P. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010 Nov;8(11):2450-7. doi: 10.1111/j.1538-7836.2010.04044.x. PMID: 20738765.
3. Woller SC, Stevens SM, Evans RS, Wray DG, Christensen JC, Aston VT, Wayne MH, Lloyd JF, Wilson EL, Elliott CG. Electronic Alerts, Comparative Practitioner Metrics, and Education Improves Thromboprophylaxis and Reduces Thrombosis. Am J Med. 2016 Oct;129(10):1124.e17-26. doi: 10.1016/j.amjmed.2016.05.014. Epub 2016 Jun 8. PMID: 27288858.
4. Darzi AJ, Karam SG, Charide R, Etxeandia-Ikobaltzeta I, Cushman M, Gould MK, Mbuagbaw L, Spencer FA, Spyropoulos AC, Streiff MB, Woller S, Zakai NA, Germini F, Rigoni M, Agarwal A, Morsi RZ, Iorio A, Akl EA, Schünemann HJ. Prognostic factors for VTE and bleeding in hospitalized medical patients: a systematic review and meta-analysis. Blood. 2020 May 14;135(20):1788-1810. doi: 10.1182/blood.2019003603. PMID: 32092132; PMCID: PMC7242782.
5. Darzi, A. J., Karam, S. G., Spencer, F. A., Spyropoulos, A. C., Mbuagbaw, L., Woller, S. C., Zakai, N. A., Streiff, M. B., Gould, M. K., Cushman, M., Charide, R., Etxeandia-Ikobaltzeta, I., Germini, F., Rigoni, M., Agarwal, A., Morsi, R. Z., Akl, E. A., Iorio, A., & Schünemann, H. J. (2020). Risk models for VTE and bleeding in medical inpatients: systematic identification and expert assessment. Blood advances, 4(12), 2557–2566. https://doi.org/10.1182/bloodadvances.2020001937Amin AN, Stemkowski S, Lin J, Yang G. Inpatient thromboprophylaxis use in U.S. hospitals: adherence to the seventh American College of Chest Physician's recommendations for at-risk medical and surgical patients. J Hosp Med. 2009 Oct;4(8):E15-21. doi: 10.1002/jhm.526. PMID: 19827045.
6. Amin, A. N., Stemkowski, S., Lin, J., & Yang, G. (2009). Inpatient thromboprophylaxis use in U.S. hospitals: adherence to the seventh American College of Chest Physician's recommendations for at-risk medical and surgical patients. Journal of hospital medicine, 4(8), E15–E21. https://doi.org/10.1002/jhm.526
7. Kahn, S. R., Lim, W., Dunn, A. S., Cushman, M., Dentali, F., Akl, E. A., Cook, D. J., Balekian, A. A., Klein, R. C., Le, H., Schulman, S., & Murad, M. H. (2012). Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl), e195S–e226S. https://doi.org/10.1378/chest.11-2296.
8. Spyropoulos AC, Lipardi C, Xu J, Peluso C, Spiro TE, De Sanctis Y, Barnathan ES, Raskob GE. Modified IMPROVE VTE Risk Score and Elevated D-Dimer Identify a High Venous Thromboembolism Risk in Acutely Ill Medical Population for Extended Thromboprophylaxis. TH Open. 2020 Mar 13;4(1):e59-e65. doi: 10.1055/s-0040-1705137. PMID: 32190813; PMCID: PMC7069762.
9. Rosenberg DJ, Press A, Fishbein J, Lesser M, McCullagh L, McGinn T, Spyropoulos AC. External validation of the IMPROVE Bleeding Risk Assessment Model in medical patients. Thromb Haemost. 2016 Aug 30;116(3):530-6. doi: 10.1160/TH16-01-0003. Epub 2016 Jun 16. PMID: 27307054.
10. Woller SC, Stevens SM, Evans RS, Wray D, Christensen J, Aston VT, Wayne M, Lloyd JF, Wilson EL, Elliott CG. Electronic alerts, comparative practitioner metrics, and education improve thromboprophylaxis and reduce venous thrombosis in community hospitals. Res Pract Thromb Haemost. 2018 Jun 7;2(3):481-489. doi: 10.1002/rth2.12119. PMID: 30046752; PMCID: PMC6046588.
11. Barkoudah E, Piazza G, Hecht TEH, Grant P, Deitelzweig S, Fang MC, Fanikos J, Kao CK, Barnes GD, Chen T, Ramishvili T, Schnipper JL, Goldstein JN, Ruff CT, Kaatz S, Schwartz A, Connors JM, Goldhaber SZ. Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients: An NATF Anticoagulation Action Initiative. Am J Med. 2020 May;133 Suppl 1:1-27. doi: 10.1016/j.amjmed.2019.12.001. PMID: 32362349.
12. Woller SC, Stevens SM, Fazili M, Lloyd JF, Wilson EL, Snow GL, Bledsoe JR, Horne BD. Post-discharge thrombosis and bleeding in medical patients: A novel risk score derived from ubiquitous biomarkers. Res Pract Thromb Haemost. 2021 Jul 7;5(5):e12560. doi: 10.1002/rth2.12560. PMID: 34263106; PMCID: PMC8265782.