Preventing Venous Thromboembolism (VTE)

VTE is a blood clot that includes pulmonary embolism (PE) in a lung and deep vein thrombosis (DVT) in an extremity.¹ It is estimated that the average additional cost for hospital-acquired VTE is $17,637.²

Risk

Risk factors for VTE include obesity, lack of physical exercise, smoking, age, male gender, surgery, fracture, minor injuries, hospitalization, heparin-induced thrombocytopenia, infection, COVID-19, inflammation, pregnancy, exogenous estrogen, exogenous testosterone, cancer, antiphospholipid syndrome, autoimmune disease, heart failure, atrial fibrillation, and kidney disease.^2,3,4,5,6

Prevention

VTE can be prevented in the acute-care setting by assessing risk, providing treatment, and reassessing with a change in condition. Patients with low risk of VTE are typically advised to ambulate and are assessed daily and with a change in condition. Patients with moderate risk of VTE are typically ordered either mechanical prophylaxis or pharmacologic prophylaxis and are assessed daily and with a change in condition. Patients with high risk of VTE are typically ordered both mechanical prophylaxis and pharmacologic prophylaxis unless contraindicated and are assessed daily and with a change in condition.⁷

Data show that VTE rates have worsened since the baseline period of 2019 (lower rates are better).

Visit the HSAG HQIC Quality Improvement and Innovation Portal (QIIP) to view your VTE data by selecting the “Measure Category” of Other Harms and “Measure” of VTE Post-Operative (PSI-12).

PSI = Patient Safety Indicator

* Rates are per 1,000 admissions.

Source: Claims data. For additional details on measure specifications, please reference the HSAG HQIC Compendium of Measures. The baseline time period is 01/01/2019–12/31/2019 and current time period is 01/01/2023–012/31/2023.

Health Equity Organization Assessment (HEOA)

HSAG HQIC is re-assessing hospitals using the HEOA to identify health equity improvements achieved in HQIC hospitals. The topics in this assessment closely align with the Centers for Medicare & Medicaid Services (CMS) health equity measures. If your facility has not yet completed the HEOA, please reach out to your quality advisor to receive a unique username for your hospital or guidance with completion.

Care Coordination Quickinar Series: Readmission Incentive and Penalty Programs

Discover ways to manage avoidable hospital readmissions by registering for these short, 30-minute webinars (quickinars)—offered monthly January through May 2024. Find details and recordings of past presentations on the webpage.

1st Tuesdays. Next: May 7, 2024 | 2–2:30 p.m. ET (11 a.m. PT)

Ensuring Medication for Opioid Use Disorder (MOUD) Treatment Through the Care Continuum

This webinar series provides strategies, interventions, and targeted solutions to ensure Medicare beneficiaries have access to MOUD treatment and facilitate the continuity of care.

Next: May 10, 2024 | 12 noon ET (9 a.m. PT).

Find on-demand quickinar recordings, slides, and podcasts from past HSAG HQIC learning series.

Quality and Safety Quickinar Series

References

1. U.S. Department of Health and Human Services. Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. (2008). http://www.ncbi.nlm.nih.gov/books/NBK44178/

2. Agency for Healthcare Research and Quality. Estimating the additional hospital inpatient cost and mortality associated with selected hospital-acquired conditions. (2017). https://www.ahrq.gov/hai/pfp/haccost2017-results.html#:~:text=Based%20on%20four%20studies%20reporting,there%20are%2043%20excess%20deaths).

3. Cushman M. et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am. J. Med. 117, 19–25 (2004). https://www.sciencedirect.com/science/article/abs/pii/S0002934304001676

4. Heit JA, Spencer FA, White RH. The epidemiology of VTE. J. Thromb. Thrombolysis 41, 3–14 (2016). https://link.springer.com/article/10.1007/s11239-015-1311-6

5. Ay C, Pabinger I, Cohen AT. Cancer-associated VTE: burden, mechanisms, and management. Thromb. Haemost. 117, 219–230 (2017). https://www.thieme-connect.com/products/ejournals/abstract/10.1160/TH16-08-0615

6. Lutsey PL, Zakai, N.A. Epidemiology and prevention of VTE. Nat Rev Cardiol 20, 248–262 (2023). https://doi.org/10.1038/s41569-022-00787-6

7. Kotaska A. VTE prophylaxis may cause more harm than benefit: an evidence-based analysis of Canadian and international guidelines. Thrombosis J 16, 25 (2018). https://doi.org/10.1186/s12959-018-0180-6

This material was prepared by Health Services Advisory Group (HSAG), a Hospital Quality Improvement Contractor (HQIC) under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication No XS-HQIC-XT-04302024-01