Venous thromboembolism risk among hospitalized patients: magnitude of the risk is staggering

Abstract

Quality assessment focuses on areas where measurement is easy and unequivocal. To determine whether high quality hospital medicine is being practiced, a natural target is assessment of the frequency of orders to implement preventive strategies against venous thromboembolism. Patient risk can be readily ascertained, and rigorous clinical trials have vetted effective strategies to prevent deep vein thrombosis and pulmonary embolism. Concentrating on reducing the risk of venous thromboembolism is worthwhile because more than 4 million surgical patients and almost 8 million medical patients warrant specific prophylaxis orders each year in the United States alone. For those who do not receive preventive measures, the result may not be apparent during the index hospitalization. More likely, such patients will tend to develop deep vein thrombosis or pulmonary embolism within the ensuing 90 days, either in a skilled nursing facility or at home in the community. It is now time for us to broaden our approach. What happens in the hospital (such as lapses in good hospital practice) does not necessarily stay in the hospital. Failure to prophylax against venous thromboembolism may have potentially devastating implications for months after hospital discharge.