The Health Roundtable3-3c_HRT1215-Session_HANNAFORD_UNSW_NSW

How many people received appropriate VTE prophylaxis?

Presenter: Natalie HannafordUNSW

Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012

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KEY PROBLEM

Approx 30,000 people are hospitalised due to VTE each year and about 2000 of those die (NHMRC 2009)

PE is responsible for about 10% of all hospital deaths (NHMRC, 2009)

The annual economic burden of VTE in Australia has been estimated to be as high as $21 Billion (Access Economics 2008)

An international audit of 70,000 patients, including Australia, found that only 50% of at-risk patients were receiving appropriate prophylaxis (Endorse study 2008; Cohen et al)

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AIM OF THE STUDY

To translate the evidence contained in the guidelines to measurable clinical indicators

To determine how many Australian patients in our sample admitted to hospital during 2009 and 2010 received appropriate VTE prophylaxis.

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Method Developed 39 clinical indicators from the NHMRC

2009 VTE prophylaxis guidelines and the ANZWP VTE prevention 2007 guidelines

Patients admitted to hospital were risk assessed for VTE Patients having a total hip replacement were prescribed

graduated compression stockings

Ratified and endorsed by 3 clinical experts

Conducted a retrospective on site medical record review using a web based encrypted data collection tool

485 participants admitted to public and private hospitals in NSW and SA 4

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RESULTS

Overall compliance - 58% (95%CI 53.3% - 63.0%)

Admitted patients risk assessed for VTE – 69%

Aggregated results surgical cases prescribed appropriate medication –

39% Hip replacement medication compliance - 55% Knee replacement medication compliance – 49%

medical admissions prescribed appropriate medication – 46%

Cancer patients with active cancer or undergoing surgery (meds & dev) – 32% 5

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RESULTS

Patients with a suspected DVT had appropriate tests- 84.6%

Patients with suspected PE had appropriate tests – 81%

Patients administered heparin therapy had it continued until the INR was therapeutic for 48 hours – 51.2%

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LESSONS LEARNT

Overall compliance was less than adequate and surprising for some conditions (orthopaedic surgery).

Obvious that some hospitals had implemented formal VTE risk assessment tools into admission documentation, but many had no means of recording/assessing this.

Still a lot of work to be done in this area to increase compliance and to understand why it remains low. 7