Advancing Patient Safety: Effective Strategies for Reducing Pulmonary Embolism and Deep Venous Thrombosis in Fracture Patients During the Perioperative Period

Abstract

Postoperative pulmonary emboli and deep venous thrombosis are significant causes of morbidity and mortality and the focus of the Agency for Healthcare Research and Quality Patient Safety Indicator 12 (PSI-12). Early identification of patients at moderate to high risk is critical for implementation of effective prophylaxis strategies. Patients at the highest risk are those who are injured or immobilized and require surgical procedures. Early intervention strategies such as mechanical prophylaxis, pharmacologic prophylaxis, ambulation, and early surgical intervention can reduce patient harm. Using retrospective case review, most postoperative PSI-12 cases at the study site were identified as fracture patients. A multidisciplinary team developed a robust approach for early identification of patients with orthopedic fractures who were at high risk for postoperative events. Interventions included a fracture alert system to identify and prioritize patients who might require early surgical intervention. Focus was placed on pharmacological prophylaxis prior to surgical intervention, and early ambulation after surgery. As a result, PSI-12 events were reduced from eight in the pre-implementation period to none following implementation. A fracture alert system and early surgical intervention with initiation of prophylaxis strategies and postoperative early ambulation can substantially reduce the rate of PSI-12 cases in patients with fractures.