Healthcare-Associated Venous Thromboembolism

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Healthcare-Associated Blood Clots: Minimize Your Risk

The Problem
Healthcare-associated venous thromboembolism (blood clots) is a significant, deadly, costly, and growing public health problem.

Prevention Can Save Lives
Proven ways to prevent blood clots from occurring during or after a healthcare encounter exist, but not all hospitals and healthcare facilities have put these prevention strategies into practice or use them routinely.

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What Is Healthcare-Associated Venous Thromboembolism?

People who are currently or recently hospitalized, recovering from surgery, or being treated for cancer are at increased risk of developing serious and potentially deadly blood clots in the form of venous thromboembolism (VTE). A blood clot that occurs as a result of hospitalization, surgery, or other healthcare treatment or procedure is called healthcare-associated venous thromboembolism (HA-VTE).

Why is HA-VTE a Public Health Problem?

Each year VTE affects as many as 900,000 Americans, resulting in about 100,000 premature deaths.^1-2 The associated health care costs $10 billion or more each year in the United States.¹ More and more people living in the United States have factors that increase their risk for a VTE. Without improvements and consistent use of strategies to prevent VTE, we expect the number of people affected by VTE to increase. Although anyone can develop a blood clot, over half of blood clots are related to a recent hospitalization or surgery and most of these do not occur until after discharge. ^3-6

A recent analysis of the National Hospital Discharge Survey (NHDS) found that each year during 2007-2009, there were on average nearly 550,000 U.S. hospitalizations of adults that had a discharge diagnosis of VTE.⁷ Fortunately, many cases of HA-VTE can be prevented. However, proven strategies to prevent HA-VTE are not being consistently or regularly applied across and within healthcare settings. Reports suggest that as many as 70% of cases of HA-VTE in patients could be prevented.^8-10 Despite this finding, fewer than half of hospitalized patients receive appropriate prevention measures.¹¹

What Is Being Done to Reduce HA-VTE?

Preventing HA-VTE in patients can result in a major decrease in overall VTE occurrence, illness, financial costs, and death. Reducing HA-VTE has been the subject of a number of patient safety and public health programs developed and promoted by federal agencies including Healthy People 2020.

CDC recognizes the need to improve, advance, and guide prevention efforts to ensure that VTE prevention is a priority across the nation’s healthcare settings. This topic was the focus of the January 15, 2013, CDC Public Health Grand Rounds and the information presented was summarized in a subsequent Morbidity and Mortality Weekly Report. Nationally, CDC’s work has guided and fostered VTE research and informed efforts throughout the country, including the Surgeon General’s Call to Action on preventing VTE.

Currently, CDC is focusing on three main areas to promote, translate and implement strategies to prevent HA-VTE:

CDC Activities

• CDC has worked with two pilot programs at Duke University Medical Center and University of Oklahoma Health Sciences Center to assess and better understand VTE occurrence. These two pilot programs will help CDC
  • Develop and evaluate methods and electronic tools to monitor the occurrence of VTE including those that are healthcare-associated.
  • Provide a more accurate picture of the health and economic impact of VTE (and HA-VTE), which will include identifying high-risk groups and settings.
  • Inform the development of improved healthcare monitoring tools to measure the success of prevention activities by tracking and monitoring trends in HA-VTE occurrence over time.
• CDC has worked with Emory University to evaluate an electronic tool for accurately identifying VTE events reported in electronic medical records.
• CDC has brought together experts on VTE to inform, promote, and guide our activities around CDC’s monitoring and prevention of healthcare-associated VTE. See meeting summaries.
• CDC has worked with partners to develop and share information for patients, healthcare providers, and the public at large to improve both awareness of VTE and methods of preventing or managing blood clots.
  • In 2015, the National Blood Clot Alliance was funded to develop a national digital media campaign that promotes the awareness of the signs, symptoms, and factors that increase the risk for blood clots www.stoptheclot.org/spreadtheword.
  • CDC also funded Duke University to develop the This Is Serious campaign. This campaign addresses how to prevent blood clots if you are a hospitalized patient, particularly if you are undergoing surgery, being treated for trauma, receiving cancer treatment, or hospitalized due to pregnancy, since these can all increase the risk to develop a blood clot.

Links of Interest

Preventing Hospital-Acquired Venous Thromboembolism: Based on quality improvement projects undertaken at the University of California, San Diego Medical Center and Emory University Hospitals, this guide assists quality improvement professionals in leading an effort to improve prevention of one of the most important problems facing hospitalized patients, venous thromboembolism.

Joint Commission’s Center for Transforming Healthcare: Learn more about what the Joint Commission and CDC are doing to prevent HA-VTE by using a problem-solving methodology incorporating tools and concepts from Lean, Six Sigma, and Change Management. This methodology will aid hospitals and healthcare systems in identifying the root causes and barriers to preventing VTE in at-risk patients.

References

1. Beckman M, Hooper WC, Critchley S, Ortel T. Venous thromboembolism: a public health concern. Am J Prev Med. 2010;38(4 Suppl):S495-501.
2. Raskob G, Silverstein R, Bratzler D, Heit J, White R. Surveillance for deep vein thrombosis and pulmonary embolism: recommendations from a national workshop. Am J Prev Med. 2010;38(4 Suppl):S502-9.
3. Streiff MB, Brady JP, Grant AM, Grosse SD, Wong B, Popovic T; Centers for Disease Control and Prevention (CDC). CDC Grand Rounds: preventing hospital-associated venous thromboembolism. MMWR Morb Mortal Wkly Rep. 2014;63(9):190-3.
4. Heit JA, Silverstein MD, Mohr DN, Petterson TM, Lohse CM, O’Fallon WM, Melton LJ 3rd. The epidemiology of venous thromboembolism in the community. Thromb Haemost. 2001;86:452–63.
5. Spencer FA, Emery C, Joffe SW, Pacifico L, Lessard D, Reed G, Gore JM, Goldberg RJ. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis. 2009;28:401-9.
6. Spencer F, Lessard D, Emery C, Reed G, Goldberg R. Venous thromboembolism in the outpatient setting. Arch Intern Med. 2007;167(14):1471-5.
7. Yusuf HR, Tsai J, Atrash HK, Boulet S, Grosse SD. Venous thromboembolism in adult hospitalizations —United States, 2007–2009. MMWR Morb Mortal Wkly Rep. 2012;61(22):401-4.
8. Zeidan AM, Streiff MB, Lau BD, Ahmed SR, Kraus PS, Hobson DB, Carolan H, Lambrianidi C, Horn PB, Shermock KM, Tinoco G, Siddiqui S, Haut ER. Impact of a venous thromboembolism prophylaxis “smart order set”: Improved compliance, fewer events. Am J Hematol. 2013;88:545-9.
9. Mitchell JD, Collen JF, Petteys S, Holley AB. A simple reminder system improves venous thromboembolism prophylaxis rates and reduces thrombotic events for hospitalized patients. J Thromb Haemost. 2012;10:236-43.
10. Lau BD, Haut ER. Practices to prevent venous thromboembolism: a brief review. BMJ Qual Saf. 2014;23:187-95.
11. Kahn S, Morrison D, Cohen J, Emed J, Tagalakis V, Roussin A, Geerts W. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev. 2013;7:CD008201-CD.