Episode 310: 309. Hospital-Associated Venous Thromboembolism Prophylaxis Use by Risk Assessment

https://shmpublications.onlinelibrary.wiley.com/doi/abs/10.1002/jhm.13350


Xu J et al. Hospital-associated venous thromboembolism prophylaxis use by risk assessment at a large integrated health care network in Northern California. J Hosp Med 2024 Jun; 19:449.

Authors took 850,000 adult nonsurgical, non–intensive care unit (ICU) hospitalizations at 21 Kaiser Permanente hospitals in northern California, and did a retrospective study of inpatient pharmacologic VTE prophylaxis, investigators compared risk assessment by admitting physicians with risk assessment according to electronic health record (EHR)-

The EHR used the Padua prediction score which basically ask yes or no questions like does the pt have active cancer, previous vte, reduce mobility, elderly age, heart or resp failure. All questions that could need a human to fill out but also with could AI or HER should be answered without humans doing anything.

In 82% of 850,000 adult nonsurgical, non–intensive care unit (ICU) hospitalizations, the EHR categorized patients as low risk (i.e., not meeting indications for pharmacologic VTE prophylaxis); however, 42% of such patients (≈300,000 patients) received pharmacologic VTE prophylaxis. Among the 18% of hospitalizations where Padua score assessments indicated high risk (i.e., met indications for pharmacologic VTE prophylaxis), only one third received pharmacologic VTE prophylaxis.

There was years of making sure people give VTE but maybe we have went to far but the only way to solve this problem is give doctors fewer patient and more time or make it incorporated into the HER automatically. Make it idiot proof.

Hospitals should begin to incorporate better validated tools within EHRs to guide clinical decision-making for inpatient VTE prophylaxis. But even without such tools, clinicians should be vigilant in applying pharmacologic VTE prophylaxis in high-risk patients and minimizing its use in patients at low risk.