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In February, the American College of Chest Physicians produced its 9th edition thrombosis guidelines. But it's a lengthy document with multiple chapters and more than 600 recommendations, and VTE prevention is only a small part of it. Besides, several VTE experts say, the document is too complicated for the average clinician to follow.
"In an effort to be more rigorous, the new guidelines avoid giving strong recommendations for certain patient groups, leaving improvement teams to standardize practice in the face of guidelines that provide less guidance than previous versions of the ACCP's reviews," Maynard says.
Mark Metersky, MD, chair of the ACCP's Guidelines Oversight Committee, acknowledges the complaints, but says critics have exaggerated the issue, and that the summary has a specific section on VTE prophylaxis.
"Nevertheless, a guideline is only as useful as it is accessible, and we're taking steps to improve that" with development of Web-based tools with yearly updates instead of every three or four years, and creation of applications for handheld devices, he says, adding that the guidelines were less specific in many areas because the committee determined that research was lacking or didn't meet its strict criteria.
Scott Grosse, PhD, a VTE expert with the Centers for Disease Control and Prevention, says that concerns the ACCP's guideline is "hard to implement" and lacked "a clear protocol" for how to do risk-based screening, prompted the CDC to weigh in. It's a concern for the CDC, which wants to develop a national hospital VTE reporting system similar to that in place for central-line bloodstream infections through the National Healthcare Safety Network, Grosse says.
As the associate director for health services research and evaluation in the division of blood disorders of the CDC's National Center on Birth Defects and Developmental Disabilities, Grosse would like to see a nationally run reporting system for hospital-acquired VTE.
With an eye to that project, the CDC has asked Merli to develop two documents. The first is a one-page simplification of the VTE problem. This will gear to the C-suite, specifically the CEO, CMO, COO, or CNO, expected before the end of the year.
Merli says the new guideline for the C-suite will explain on one sheet "what the problem is, what government regulations are coming, such as requirements for reporting, and what information, tools, and guidelines are out there."
He adds that most hospital executives don't have this on their radar yet. They don't realize that not only does VTE increase patient length of stay, which increases costs, but soon, VTE also will become a reportable hospital-acquired condition, which will be reported nationally in Hospital Compare. "CEOs need to drive this process," Merli says.
"The CEO will read this and say, 'We have got to do this,' will take it to their technology people and say, 'Let's put this in our electronic health record system, or if we don't have an EHR, let's do order sets or pathways.' "
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