Preventing Hospital-Associated Venous Thromboembolism

Pulmonary embolism resulting from deep vein thrombosis—collectively referred to as venous thromboembolism—is the most common preventable cause of hospital death. Pharmacologic methods to prevent venous thromboembolism are safe, effective, cost-effective, and advocated by authoritative guidelines, yet large prospective studies continue to demonstrate that these preventive methods are significantly underused. Based on quality improvement initiatives undertaken at the University of California, San Diego Medical Center and Emory University Hospitals, this guide assists quality improvement practitioners in leading an effort to improve prevention of one of the most important problems facing hospitalized patients, hospital-acquired venous thromboembolism.

Acknowledgments

The author would like to acknowledge those who contributed to the first version of the guide, most notably Dr. Jason Stein of Emory University. Dr. Maynard has also been inspired by all those who have engaged in collaborative improvement efforts using the previous version of this guide; these have greatly informed this updated and revised version.

In addition, many individuals contributed a great deal of their time and expertise to the development of the revised guide. For their expert input, the author gratefully acknowledges the following individuals from the Centers for Disease Control and Prevention (CDC):

• Michele G. Beckman, M.P.H., Epidemiologist, National Center on Birth Defects and Developmental Disabilities;
• Scott Grosse, Ph.D., Research Economist, National Center on Birth Defects and Developmental Disabilities; and
• Lisa C. Richardson, M.D., M.P.H., Director of Division of Cancer Prevention and Control

From the Center for Quality Improvement and Patient Safety at AHRQ:

• Barbara Bartman, M.D., M.P.H., Medical Officer and AHRQ VTE clinical expert advisor;
• Jeff Brady, M.D., M.P.H., Rear Admiral, U.S. Public Health Service and Director, CQuIPS;
• Eileen M. Hogan, M.P.A., Public Health Analyst.

Finally, AHRQ and the author acknowledge the patients and families who have shared their personal stories about the impact VTE had on their lives and their insights into the importance of prevention efforts.

Peer Reviewers

Before publication of the revised guide, AHRQ sought input from independent peer reviewers without financial conflicts of interest. Please note that the conclusions and information presented in this guide do not necessarily represent the views of individual reviewers. The list of peer reviewers follows:

Alpesh N. Amin, M.D.
Chair, Department of Medicine; School of Medicine, University of California, Irvine
Irvine, CA

David Garcia, M.D.
Professor, University of Washington School of Medicine, University of Washington
Seattle, WA

William Geerts, M.D.
Affiliate Scientist, Sunnybrook Health Sciences Centre
Toronto, ON

Elliott Richard Haut, M.D., Ph.D.
Fellowship Director, Trauma/Acute Care Surgery Fellowship and Associate Professor of Surgery, The Johns Hopkins Hospital
Baltimore, MD

Michael Gould, M.D., M.S.
Director for Health Services Research and Implementation Science, Kaiser Permanente Southern California
Pasadena, CA

Gary E. Raskob, Ph.D.
Dean and Regents Professor, College of Public Health, The University of Oklahoma Health Sciences Center
Oklahoma City, OK

Michael Streiff, M.D.
Medical Director, Anticoagulation Management Service and Outpatient Clinics and Associate Professor of Medicine, The Johns Hopkins Hospital
Baltimore, MD

Richard H. White, M.D.
Chief of General Medicine and Professor of Medicine, University of California, Davis
Center for Healthcare Policy and Research, Lawrence J. Ellison Ambulatory Care Center, General Medicine
Sacramento, CA

Neil A. Zakai, M.D., M.Sc.
Associate Professor of Medicine, Hematology/Oncology Division, Department of Medicine and Associate Professor of Pathology and Laboratory Medicine
University of Vermont College of Medicine, Colchester Research Facility
Colchester, VT  

Disclaimer and Copyright Information

The author discloses that he has acted as an expert in cases involving venous thromboembolism (VTE). Dr. Maynard also sits on an expert review panel for a phase 3 study on rivaroxaban for VTE prophylaxis in medical patients (Mariner study, Janssen Pharmaceuticals). He has no other affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, grants, patents received or pending, or royalties) that conflict with material presented in this guide.

This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated.

Suggested Citation: Maynard G. Preventing hospital-associated venous thromboembolism: a guide for effective quality improvement, 2nd ed. Rockville, MD: Agency for Healthcare Research and Quality; October 2015. AHRQ Publication No. 16-0001-EF.