Venous Thromboembolism Prophylaxis Seen As Way To Make Hospital Safer
For Grady Patients
An Emory University School of Medicine hospitalist at Grady Memorial
Hospital has helped develop and implement clinical guidelines for venous
thromboembolism (VTE) prophylaxis, a protective treatment that helps
prevent blood clots from forming. The guidelines, which were initiated
by the Emory School of Medicine at Grady in an attempt to provide high
quality patient care, are intended to help prevent VTE among hospitalized
medical patients at Grady. VTE is one of the main causes of morbidity
and mortality among patients in hospitals. This life-threatening condition
further complicates the pre-existing disease for which the patient was
initially admitted to the hospital, and occurs when a blood clot forms
in the deep vein system and may become dislodged and travel to the lungs.
Depending on the size of
the thrombus and which blood vessel it is obstructing, the result can
range from a complete lack of symptoms to a life-threatening emergency.
Valery Akopov, M.D., a hospitalist
and assistant professor of medicine, recently teamed with Amy Raufman,
Pharm D, BCPS, a clinical pharmacist at Grady, and Suma Dromazali, M.D.,
a third-year medical resident, to establish clinical guidelines. As
a hospitalist, Dr. Akopov spends at least 25 percent of his time providing
care to hospitalized patients and is considered an expert in inpatient
medicine. He and Raufman formed a multidisciplinary team and developed
steps for the prevention of VTE, which involved identifying patients
on medical wards who needed prophylaxis medications and determining
how many were receiving prophylaxis, raising awareness among physicians
and house staff through lecture series known as grand rounds, and implementing
a mandatory admission form that requires eligible hospitalized patients
be given heparin, an anticoagulant, that reduces the formation of blood
clots. Coumadin, another blood thinner, is also given at times, along
with compression stockings that are worn to prevent blood clots in someone
who is bedridden.
The new guidelines have been
approved by the Center for Clinical Effectiveness, a Grady Hospital
committee. The CCE serves as a primary resource for Grady to identify
major problems in the delivery of health care and provide innovative
solutions to optimize the delivery of high quality, cost-effective patient
care.
"Potentially, if we improve
adherence of physicians with clinical practices that are directed to
decrease the incidence of thromboembolism, we can make hospitals a safer
place and save lives by preventing this condition from occurring," Akopov
said.
"Our patients are really
much safer now than they were before this hospital-wide implementation
of guidelines," Akopov continued. "This project shows that putting in
place some kind of intervention clearly can improve adherence with the
national guidelines for prophylaxis."
Akopov said one of the major
risk factors for VTE is immobilization, either from medical illness
or surgical illness, which causes circulation to stagnate. Surgery,
congestive heart failure, pneumonia, and lung infections are other risk
factors for VTE. Anyone older than age 65 is also at much higher risk
of developing blood clots once they are hospitalized and become immobile.
Venous
thromboembolism can often be fatal because once a clot is formed, it
may detach from the vein and travels to other parts of the body such
as the lungs. Nationally, Akopov said that 15 percent to 20 percent
of hospitalized patients who are admitted to a medical floor will develop
blood clots. By applying appropriate prophylaxis, that number can be
reduced to as low as 5 percent. There is no data available on the rate
of illness and death from VTE at Grady.
"Systematic and consistent
prophylaxis of VTE makes the hospital a safer place for patients, and
really serves as one of the markers for quality of care in hospitals,"
Akopov said. An Emory University School of Medicine hospitalist at Grady
Memorial Hospital has helped develop and implement clinical guidelines
for venous thromboembolism (VTE) prophylaxis, a protective treatment
that helps prevent blood clots from forming. The guidelines, which were
initiated by the Emory School of Medicine at Grady in an attempt to
provide high quality patient care, are intended to help prevent VTE
among hospitalized medical patients at Grady. VTE is one of the main
causes of morbidity and mortality among patients in hospitals. This
life-threatening condition further complicates the pre-existing disease
for which the patient was initially admitted to the hospital, and occurs
when a blood clot forms in the deep vein system and may become dislodged
and travel to the lungs.
Depending on the size of
the thrombus and which blood vessel it is obstructing, the result can
range from a complete lack of symptoms to a life-threatening emergency.
Valery Akopov, M.D., a hospitalist
and assistant professor of medicine, recently teamed with Amy Raufman,
Pharm D, BCPS, a clinical pharmacist at Grady, and Suma Dromazali, M.D.,
a third-year medical resident, to establish clinical guidelines. As
a hospitalist, Dr. Akopov spends at least 25 percent of his time providing
care to hospitalized patients and is considered an expert in inpatient
medicine. He and Raufman formed a multidisciplinary team and developed
steps for the prevention of VTE, which involved identifying patients
on medical wards who needed prophylaxis medications and determining
how many were receiving prophylaxis, raising awareness among physicians
and house staff through lecture series known as grand rounds, and implementing
a mandatory admission form that requires eligible hospitalized patients
be given heparin, an anticoagulant, that reduces the formation of blood
clots. Coumadin, another blood thinner, is also given at times, along
with compression stockings that are worn to prevent blood clots in someone
who is bedridden.
The new guidelines have been
approved by the Center for Clinical Effectiveness, a Grady Hospital
committee. The CCE serves as a primary resource for Grady to identify
major problems in the delivery of health care and provide innovative
solutions to optimize the delivery of high quality, cost-effective patient
care.
"Potentially, if we improve
adherence of physicians with clinical practices that are directed to
decrease the incidence of thromboembolism, we can make hospitals a safer
place and save lives by preventing this condition from occurring," Akopov
said.
"Our patients are really
much safer now than they were before this hospital-wide implementation
of guidelines," Akopov continued. "This project shows that putting in
place some kind of intervention clearly can improve adherence with the
national guidelines for prophylaxis."
Akopov said one of the major
risk factors for VTE is immobilization, either from medical illness
or surgical illness, which causes circulation to stagnate. Surgery,
congestive heart failure, pneumonia, and lung infections are other risk
factors for VTE. Anyone older than age 65 is also at much higher risk
of developing blood clots once they are hospitalized and become immobile.
Venous
thromboembolism can often be fatal because once a clot is formed, it
may detach from the vein and travels to other parts of the body such
as the lungs. Nationally, Akopov said that 15 percent to 20 percent
of hospitalized patients who are admitted to a medical floor will develop
blood clots. By applying appropriate prophylaxis, that number can be
reduced to as low as 5 percent. There is no data available on the rate
of illness and death from VTE at Grady.
"Systematic and consistent
prophylaxis of VTE makes the hospital a safer place for patients, and
really serves as one of the markers for quality of care in hospitals,"
Akopov said. |