[MUSIC]. Today we're going to talk about the importance of Venous Thromboembolism or VTE in the world of patient safety. First, I want to explain what is VTE. Venous Thromboembolism are blood clots, and they're usually thought to comprise Deep Vein Thrombosis, or DVT and Pulmonary Embolism, PE. The DVT forms in the leg and moves along the blood vessels into the lungs, and becomes a pulmonary embolism. Virchow's triad is the thought of what causes patients to be at risk for VTE. And this includes stasis, vessel wall injury, and hypercoaguability where the blood is kind of too thick and more prone to clot. So why should we as patient safety experts focus on Venous Thromboembolism? First of all, VTE is very common. It affects at least 350,000 to 600,000 Americans every year. It's also deadly. It kills more than 100,000 Americans every year, which to put it in scope is more deaths than occur combined from breast cancer, motor vehicle collisions, and AIDs. That information was from the report from the Surgeon General. And as you can see here, we hosted the Surgeon General at John Hopkins' medicine to highlight the importance of DVT and PE prevention. And this was nearly ten years ago. There are many risk factors for Venous Thromboembolism in hospitalized patient. And almost every single patient in the hospital is going to be at risk for VTE. VTE is more common in older patients. It's patients with cancer, patients getting chemotherapy, anybody with a prior DVT or PE. We really think about it in patients with major surgery, trauma, orthopedics for joint replacement. All patients are going to be at risk for VTE. Pregnancy is a known risk factor, and there's also different medications like hormone therapy. Patients with stroke, cardiac disease, respiratory disease. It's medical patients. It's surgical patients. It's obstetrics patients. It can even happen in pediatrics and in psychiatry. Every patient in the hospital is at risk for VTE. Another important reason to focus to VTE is the increased cost. Every patient that has a VTE event costs significant amount of money. These might be only 10 or 15 or maybe $20,000 per patient. But when you held up the huge number of patients this effects, this turns into a really large amount of money. The annual direct costs are over $250 million just for venous stasis/ulcer care alone. And when you look at all cost attributable to VTE in the United States, the number is somewhere between 7 and $10 billion according to the CDC. Why else should we focus on VTE? VTE is mostly preventable. I don't want people to think we can prevent every single one, but there are things we should do in patient safety to improve our care. A few years ago, it was thought that VTE could be listed as a never event. However, that really is not the case. Not all events are preventable. For example, we looked at a population that's at high risk for VTE, and patients who are undergoing joint replacements, whether it'd be hip or knee replacement. And we looked at patients in eight randomized controlled trials and found that even patients in the good arm, the ones getting the best practice, the best care prophylaxis were still having symptomatic VTE, had a rate of as high as 2.5%. So if you can't make it disappear completely even in these randomized clinical trials, there's no way you can make it disappear completely in the real world. And this is just a reminder that prophylactic regimens do not prevent all thrombotic events. Although, I would say, we should push it as best we can for the best prophylaxis for patients. That being said, there are excellent evidence based guidelines about VTE prevention in hospitalized patients. Some are very general and they cover many different specialties, for example, the American College of Chest Physicians has a very dense compendium of information for what to do on many different patient types. Others are from specific organizations with very narrow focus. For example, the Eastern Association for the Surgery of Trauma. East is a trauma organization, and we have guidelines about trauma care. Orthopedic surgeons have guidelines about VTE prevention in orthopedics. Same things for OBGYN or the American College of Physicians. There are great guidelines out there, and we should be using them. Unfortunately, DVT and VTE prophylaxis in general is vastly underutilized. This is one study from about ten years ago which shows that only 40% of patients had received prophylaxis for VTE while they were in the hospital. And these are patients who then have DVT events. More recently, this large multinational study of almost 70,000 patients in over 350 hospitals in 32 countries around the world showed that patients are not getting appropriate care. Surgical patients get about 60% of the appropriate care they should, and medical patients are getting about 40% of the appropriate care being compliant with appropriate guideline driven prophylaxis. We're not doing a good job, we're failing our patients. In fact, the American Public Health Association came out with a white paper. And my favorite quote from the paper says the disconnect between evidence and execution as it relates to DVT prevention amounts to a public health crisis The Agency for Healthcare Research and Quality or AHRQ has stated that DVT related PE is the most common cause of preventable hospital death. And that prophylaxis of at risk patients is the number one strategy to improve patient safety. We should care about DVT and PE. And there's a new report from the Agency for Healthcare Research and Quality AHRQ with a critical analysis of evidence for patient safety practices. They came up with their top ten list of strongly encouraged patient safety practices. And on the list is interventions to improve prophylaxis access for VTE. And when you read chapter 28, which I was honored to co-write with my co-writer, prevention of VTE, we summarized the evidence. And this was picked as one of the strongly encouraged patient safety practices. And you can see the link here to go and take a look at more information about what we should do according to AHRQ.
