K. L. Florecki1, B. Lau1, O. Owodunni1, J. Sakran1, M. Streiff1, E. Haut1 1The Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction: Venous thromboembolism is a common complication associated with significant morbidity and mortality in the trauma population. We strived to characterize the true preventability of venous thromboembolism (VTE) in the trauma patient population and the patients who receive “defect-free care” prophylaxis for VTE.
Methods: Retrospective review of trauma patients with hospital-acquired VTE (including deep vein thrombosis [DVT] and/or pulmonary embolism [PE]) identified at The Johns Hopkins Hospital from January 2008 – June 2016. Data on patient risk assessment for VTE, prescription of risk-appropriate VTE prophylaxis and pharmacologic VTE prophylaxis medication administration were extracted from the electronic health record system. Patients were dichotomized into prophylaxis failure vs. defect-free care, defined as receiving all doses of risk-appropriate VTE prophylaxis recommended by our validated, mandatory computerized clinical decision support tool. Prophylaxis failure was divided into prescription failures or dose-administration failures (missed doses).
Results: 92 trauma patients had hospital-acquired VTE. All 92 (100%) were assessed using the VTE risk assessment mandatory computerized clinical decision support tool, however only 75 (81.5%) were prescribed risk-appropriate prophylaxis. Of the 92 patients, 33 (35.9%) received defect free-care. Of the 59 (64.1%) who received suboptimal care, 17 (28.8%) were not prescribed risk-appropriate prophylaxis and 42 (71.2%) missed at least one dose of pharmacologic VTE prophylaxis.
Conclusion: Our study identifies the need to reevaluate outcome and process measures for VTE prevention after trauma. 33 VTE events occurred in patients who received best-practice defect-free care, showing not all VTE are truly preventable, and should not be included in outcome measures as “potentially preventable events.” Our findings also identify specific targets and emphasize the importance of ongoing efforts to improve prescription and administration of risk appropriate VTE prophylaxis in trauma centers.