The Health Roundtable 3-3c_HRT1215-Session_HANNAFORD_UNSW_NSW How many people received appropriate VTE prophylaxis? Presenter: Natalie Hannaford UNSW Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct
The Health Roundtable 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) 2
The Health Roundtable 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. 3
The Health Roundtable 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
The Health Roundtable RESULTS Overall compliance - 58% (95%CI 53.3% %) 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
The Health Roundtable 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% 6
The Health Roundtable 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