Eradication of hospital-acquired venous thromboembolism

Abstract

Pulmonary embolism (PE) causes nearly 200,000 deaths annually in the United States alone. The magnitude of the risk for acquiring venous thromboembolism (VTE) in U.S. hospitals is staggering (1). About 8 million Medical Service and 4 million Surgical Service patients are at moderate or high risk for developing VTE each year (2). The surgeon General has declared that PE is the most preventable cause of death within hospitals (3). Thus, a spotlight shines brightly on quality control and quality improvement practices within American hospitals (4) to ensure that maximum effort is exerted to prevent PE and deep venous thrombosis (DVT). A convergence of passionate advocates (5), including health care providers, patients, and governmental authorities, will transform the status quo and enable eradication of hospital-acquired VTE. Catalysts for VTE eradication are listed in Table 1. Failure to prevent in-hospital PE and DVT will no longer be tolerated. For example, Medicare and Medicaid will have stopped reimbursing hospitals for incremental care needed to treat postoperative total hip or knee replacement patients who develop VTE (6). Whether this new policy is wise or equitable is debatable (7), but its influence in augmenting VTE prophylaxis and in decreasing the rate of postoperative VTE is undeniable. We have entered a new era that focuses on venous disease. This contemporary heightened awareness to VTE prevention constitutes a remarkable achievement. Only a decade ago, VTE was an orphan disease which received only a modicum of attention from major cardiology, pulmonary, and haematology specialty societies. Major organisations representing these specialties were concerned about VTE but did not embrace the field as a top priority. Transformative champions who had argued in favour of paying more attention to preventing venous thrombosis had to compete with more forceful voices that favoured emphasis on more traditional core subject matter for each organisation. Examples are acute coronary syndrome for cardiologists, asthma/chronic lung disease for pulmonologists, and leukaemia/lymphoma for haematologists. Venous disease education tended to be handled as an “afterthought.” Discussion of VTE’s wide scope and potential for harm did not capture the imagination of professionals or the public. Apathy was a common response when the subject of VTE was raised. There was no unifying push toward universal protection of hospitalised patients against DVT and PE.