Healthy Connections - February, 2010

Resource Center

Protocol to prevent hospital-wide blood clots

Setu Vora, MD Imagine if you could create a way to save five patients' lives a year. Not through a heroic, expensive or even complicated measure, but by using a proven protocol. Such is the case for Backus Hospital physicians, and a protocol for preventing hospitalacquired blood clots.

"This is a hospital-wide initiative to address the most serious patient safety issue that has been identified," said Stephen Briggs, MD, Medical Staff President. "I am proud of our Medical Executive Committee for providing its unanimous support for the project. To sum it up, it's simply the right thing to do."

A pulmonary embolism resulting from deep vein thrombosis (VTE) is the most preventable cause of hospital death, according to several published studies.

Indeed, most hospitalized patients have at least one risk factor for VTE, and surgical patients without proper precautions are at an unacceptably high risk.

The creation of a universal, mandatory VTE protocol designs reliability into the process, said Setu Vora, MD, Quality and Safety Officer for the Departments of Internal Medicine and Family Practice at Backus.

"It does not force us to prescribe, but it does force us to assess the risk and take appropriate action for our patients," Dr. Vora said. "Really, from a patient safety and quality perspective, this is a no-brainer."

That's not to say the protocol was devised effortlessly.

Over six months, a team created a method to demonstrate areas of risk, using rounds reports from physicians and nurses, developed a prospective database of VTE prevention measures, and designed a registry to track cases of hospital-acquired VTE. All of this preceded the design and testing of the actual protocol.

In the end, the most important aspect of the project was the Medical Executive Committee's leadership, said Dave Whitehead, Backus President and Chief Executive Officer. "As a group, the MEC was the champion to move this forward, hospitalwide," he said. "That reflects on our physicians' commitment to patients, and their safety."

A quick calculation using national norms proves how valuable the protocol can be. A typical 200-bed hospital that lacks a systematic approach to VTE prevention can expect about 100 cases of hospital-acquired VTE a year. Of those, about 50 could have been prevented. On average, 10% of inpatient deaths result from pulmonary embolisms. That means five preventable patient deaths.

"The protocol is good basic medicine. It prompts us to do the right thing at the right time - all the time," said Peter Shea, MD, Senior Vice President and Chief Medical Officer.

The protocols dovetail with best practices nationwide and recommendations from the Joint Commission, which accredits hospitals.

There will be a hospital-wide launch of the protocol, which includes a risk assessment by physicians and documentation, in February.

According to the U.S. Surgeon General, 350,000 to 600,000 people in the United States develop blood clots every year, with more than 100,000 deaths. This means that about 1 out of 3 people with venous blood clots die each year.

"The consequences of not following protocols for VTE can be devastating to patients," said Ashan Manohar, MD, a gastroenterologist and member of the Backus Medical Executive Committee. "This is a high priority for the hospital and as physicians we should all take this very seriously. It addresses something that is truly preventable."

Deep vein thrombosis mainly affects the large veins in the lower leg and thigh. The clot can block blood flow. If the clot breaks off and moves through the bloodstream, it can get stuck in the brain, lungs, heart, or other areas, leading to severe damage.

Risk factors for blood clots

High risk

Hospitalization
Major surgery, such as abdominal pelvic surgery
Knee or hip replacement
Major trauma: auto accident or fall
Nursing home living
Leg paralysis

Moderate risk