Background: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality for hospitalized patients. There are approximately 900,000 new VTE events and 100,000 VTE-related deaths every year. In the United States, more deaths occur due to VTE than breast cancer, AIDS, and motor vehicle accidents combined. VTE are considered preventable events with appropriate prophylaxis; however, prophylaxis is frequently delayed on hospital admission. With this information in mind, we chose to investigate the incidence of VTE prophylaxis delays for 100 high-risk patients admitted to our institution’s regional medical centers between December 2018 and March 2019. We performed a retrospective chart review and calculated the Padua Prediction Score for these 100 patients to assess our medical center’s adherence to VTE prophylaxis guidelines. Our aim is to reduce VTE prophylaxis delays by 75% in the next year for all high-risk patients admitted to the medical floor. We believe this goal could be accomplished by initiating a VTE prophylaxis standard order set in our hospitals’ Emergency Departments.
Methods: This was a retrospective study of 100 medically ill patients admitted to the medical floor from the Emergency Department at two regional medical centers from December 2018 to March 2019. Data collection consisted of patient demographics, length of stay, timing of prophylaxis for VTE, type of VTE prophylaxis, and Padua Prediction Score.
Results: The first dose of prophylaxis was given within 24 hours of arrival to 75% of patients, with only 25% of patients receiving their first dose within 8 hours. Of all 100 patients, 13 patients did not receive prophylaxis during their hospital stay. Also, the length of time between prophylaxis order and administration of the first dose showed that 74% of patients received prophylaxis within 12 hours. Only 36% of patients received prophylaxis in under 4 hours from the time the order was placed. 62% of patients were identified as having a Padua score of greater than or equal to 4 at the time of admission, suggesting significant risk for VTE. It is important to consider that 2 of the patients expired during admission, 3 patients developed VTE, and 95% of patients had no significant adverse outcomes.
Conclusions: Our investigation revealed that there was a disparity in length between time of admission and first dose of prophylaxis. For example, only 2% of patients received prophylaxis in the first 4 hours of arriving at the hospital. The study also showed a mortality rate of 2%, with 3% of all patients developing a VTE. These results would require further study to demonstrate a relationship between delays in VTE prophylaxis and adverse outcomes in the medically ill population. Within our integrated healthcare system, there is a significant variation in order placement for VTE prophylaxis that can be addressed through standardization of a VTE prophylaxis ordering set. Routine ordering was commonly encountered in our chart review, causing significant delays in VTE prophylaxis. We recommend implementation of a standard STAT order for patients at high risk for VTE according to the Padua Prediction score to receive prophylaxis by the admitting team and then a routine order to follow.