PULMONARY VASCULAR DISEASE

VTE, encompassing DVT and pulmonary embo-lism (PE) is common, with an incidence of one in 1,000, and is associated with signifi cant morbidity and mortality. 1,2 One-half of all VTE episodes are provoked by either surgery or hospitalization with a medical ill-ness. 3 Prevention of VTE associated with hospitalization is a key patient safety priority for hospitals. 4 Throm-boprophylaxis with anticoagulants, mechanical methods, or both is known to significantly and safely reduce the risk of hospital-associated thrombosis (HAT). 5,6 Given the concomitant increased risk of bleeding asso-ciated with anticoagulant prophylaxis, individualized Background: VTE is a common complication of hospitalization and is associated with signifi cant morbidity and mortality. The use of appropriate thromboprophylaxis can signifi cantly reduce the risk of VTE but remains underutilized. In England, a comprehensive approach to VTE preven-tion was launched in 2010. This study aimed to evaluate the impact of the implementation of the national program in a single center. Methods: A prospective quality improvement program was established at King’s College Hospital NHS Foundation Trust in 2010. The multidisciplinary thrombosis team launched mandatory doc-umented VTE risk assessment and updated thromboprophylaxis guidance. Root cause analysis of hospital-associated thrombosis (HAT) was implemented to identify system failures, enable out-come measurement, and facilitate learning to improve VTE prevention practice. The key out-comes were the incidence of HAT and the proportion of events preventable with appropriate thromboprophylaxis. Results: Documented VTE risk assessment improved from , 40 % to. 90 % in the fi rst 9 months. Four hundred twenty-fi ve episodes of HAT were identifi ed over 2 years. A signifi cant reduction in the incidence of HAT was observed following sustained achievement of 90 % risk assessment (risk ratio, 0.88; 95 % CI, 0.74-0.98; P 5.014). The proportion of HAT attributable to inadequate thromboprophylaxis fell signifi cantly from 37.5 % to 22.4 % ( P 5.005). Conclusions: Mandatory VTE risk assessment can signifi cantly reduce preventable HAT and thereby improve patient safety. CHEST 2013; 144(4):1276–128