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News

Venous Thromboembolism Prophylaxis seen as way to make hospital safer for Grady patients

Emory University : 13 December, 2003  (Technical Article)
An Emory University School of Medicine hospitalist at Grady Memorial Hospital has helped develop and implement clinical guidelines for venous thromboembolism 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 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.
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