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Learning Objective 1: Describe the relationship between venous thromboembolism prevention and the role of nursing care delivery.
Learning Objective 2: Critique the impact of acute care, emergency services and outpatient services on venous thromboembolism occurrences.
Hospital-acquired venous thromboembolisms (HA-VTEs) are associated with increased mortality, morbidity, and cost in the U.S. and globally. This study investigated discrete steps of the hospital-acquired and non-hospital-acquired venous thromboembolism (VTE) prophylaxis process in a cross-section of medical and surgical patients at two community acute care hospitals. The purpose of the study was to 1) identify trends in flow from inpatient, emergency service and outpatient procedures, and 2) explore nursing unit volumes, pharmaceutical charges, and attending physician admission patterns for patients with VTE.
Methodology
This was a retrospective descriptive study of medical and surgical inpatients, 18 years and older, between October 2007 and March 2010 with a VTE diagnosis. Nurse abstractors collected data from inpatient charts on VTE risk factors and contraindications to treatment, as well as the prophylaxis process. Additional data sources included inpatient, emergency services and outpatient surgery discharge claims, along with patient detail charge files.
Results:
The sample included 3,651 patients. VTE patient admissions were distributed among 80 percent of the nursing units with only minor trends in volume consistency. Pharmaceutical charges for VTE treatment were consistently higher than were charges for prophylaxis treatment, suggesting that cost savings is possible with prophylaxis. Impact of post-discharge emergency services and pre-admission outpatient surgery demonstrated trends for certain diagnoses.
Conclusion and Implications:
Exploration of emergency and outpatient activity before and after the VTE events indicated that outpatient surgery procedures commonly preceded the VTE event, suggesting that outpatient surgery protocols for VTE prophylaxis warrants inclusion in VTE studies. Distribution of both HA and non-HA VTE patients among nursing units was widespread, as was the range of total hospital and pharmaceutical charges and the number of physicians attending to VTE patients. Implications to deliver the specialized care required includes collaborative practice models with physicians, pharmacists, nurses, and providers in outpatient surgery services.