By mid-November, Merli's group will complete a second document, this one a 10- to 15-page synopsis about VTE prevention geared to clinicians and the C-suite. Merli says that VTE experts around the country are working to create a three-part document that offers practical recommendations for VTE risk assessment, bleeding risk assessment, and recommendations for preventing VTE.
"We're going to make it easy for them to follow the process; give them something that's not confusing.
The guidance may not pass the ACCP's strict standards for guidance, but it's based on the best experts'
Merli says that because the problem is still so enormous but preventable, "what I think this is all going to come to is that every hospital in the country is going to have to report its VTE hospital-acquired condition rate, like we report infections."
At Jefferson, Merli says, VTE prophylaxis and risk assessment systems are so strict, the computer system will not let physicians place further orders unless the patient is risk assessed and appropriate prophylaxis against VTE is placed.
"Our model is such that it pushes the physician through the process," Merli says. "The first thing it asks you is, what is the patient's risk of DVT? The second thing it asks is if the patient has some risk, what surgery are they having, and if it's orthopedics, for example, you click on that and it tells you the recommended prophylaxis."
At Jefferson today, Merli says, 98% of patients who should receive prevention strategy get it. Another benefit of this strategy is that it helps reduce the need for purchasing drugs and compression sleeves that aren't needed, an attractive motivation for hospitals today.
Gregory Piazza, MD, a member of the 793-bed Brigham & Women's Hospital VTE research group in Boston and a director of the North American Thrombosis Forum, agrees with Merli and Maynard that complex guidelines and patients keep many hospitals from preventing VTE death and morbidity in their patients.
"We haven't isolated one risk stratification tool that everybody can use, and some of the tools we have are
Because of that, he says, "we still have a lot of work to do yet to educate the medical community about how serious in-hospital VTE is. Physicians and other providers just have so much on their plates, and to be truthful, the type of patients they see in the hospital or in the ER are so incredibly complicated. It's not just pneumonia, but also blood sugars out of control, kidney function, impaired heart failure.
"VTE prophylaxis is not one of the top five or 10 things that need to be addressed. But what we need to do is remind them it has to be a priority."
But times are changing rapidly for this field of medicine, he says. "You'll be hard-pressed to find another field in medicine that's undergoing the frequency and extensive changes that VTE is. And we have new medications coming out every month and new studies showing efficacy and safety of each agent."