Prevention of venous thromboembolism in Department of Veterans Affairs hospitals.

Abstract

BACKGROUND: Pulmonary embolism (PE) is the most common preventable cause of death in hospitals, but many patients do not receive proven preventive therapies. OBJECTIVE: To ascertain the extent to which inpatients received therapies for the prevention of venous thromboembolism (VTE). DESIGN: Medical records review of a random sample of hospitalized patients, stratified by hospital teaching status. SETTING: Department of Veterans Affairs (VA) acute-care hospitals. PATIENTS: Two groups hospitalized >or=48 hours during the year ending March 31, 2007: (1) all 4963 patients older than 74 years with a principal discharge diagnosis of heart failure; and (2) all 1448 patients with any discharge diagnosis of PE. MEASUREMENTS: Rate of VTE preventive care. RESULTS: Sixty-three of the 100 randomly selected heart failure patients had adequate anticoagulation, 29 (46%) of whom were taking warfarin for chronic conditions. For patients discharged with a PE diagnosis, records from all 330 nonteaching and 449 (40%) teaching hospital cases were reviewed. Most cases (698; 90%) were excluded because there was only a remote history of PE or the diagnosis was made prior to admission. Thirty-four of the 63 patients (54%) with confirmed in-hospital PE and unequivocal VTE risk factors received appropriate preventive treatment. Thirty of the 66 patients (48%) with missed opportunities for prevention had inappropriate mechanical prophylaxis or inadequate use of anticoagulation. CONCLUSIONS: In hospitalized veterans with PE or at risk for VTE, missed opportunities for prevention were frequent and included inappropriate or inadequate interventions. Retrospective chart review was an inefficient method for identifying patients with in-hospital PE.