背景:医院获得性静脉血栓栓塞症(HA-VTE)定义为发生在医院和入院后90天内的静脉血栓栓塞症(VTE)病例。深静脉血栓形成(DVT)最常见于骨盆和腿部的深静脉内。如果血栓脱落并转移到肺部,它可以导致肺栓塞(PE)。VTE与显著的发病率和死亡率相关,占所有医院死亡人数的近10%。如果正确识别了危险因素并规定了VTE预防措施,VTE可能是一种可预防的疾病。2010年,NHS英格兰启动了国家静脉血栓栓塞预防计划。这包括NICE指导,和VTE风险评估工具,至少95%的患者必须在入院时完成。国家血栓形成调查,由英国血栓形成,研究了这个项目是如何在当地实施的,并在全国范围内审核HA-VTE预防策略。
目的:使用血栓形成调查和NICE指导作为辅助,本研究收集了盖茨黑德伊丽莎白女王医院(QEH)的医院获得性DVT(HA-DVT)数据,旨在:1.确定HA-DVT的病例并了解这些病例的临床情况2.在QEH3评估VTE预防措施的质量。概述该医院降低HA-VTE发生率的潜在改善方法:这项回顾性队列研究使用电子记录识别2019年4月至2022年4月QEH期间的所有DVT病例。HA-DVT病例被定义为:阳性超声多普勒报告和病例发生在住院后90天内,或超过两天进入录取。对于这些HA-DVT病例,我们记录了以下情况:入院原因;入院专科;存在潜在的活动性癌症和在诊断后90天内发生的死亡.我们评估了VTE预防措施的质量,通过记录:完成VTE风险评估;调整体重的药物VTE预防处方和出院时提供VTE预防。对于住院90天内发生的HA-DVT病例,预防措施是在最初入院时评估的。在此时间段内,使用电子记录记录所有住院患者的国家VTE风险评估工具的完成率。
结果:所有入院的98.5%完成了VTE风险评估工具。在2019年4月至2022年4月期间,发现了135例HA-DVT。16例HA-DVT患者入院时未进行VTE预防。这些患者中有11人清楚地记录了避免抗凝的原因。在规定了药物预防VTE的HA-DVT病例中,23%的人被规定了不合适的体重剂量。如果出院时需要抗凝,在94%的病例中,这种规定是适当的。约31%的HA-DVT患者有潜在的活动性恶性肿瘤。39例患者在诊断出DVT后90天内死亡;仅有1例VTE被认为是导致死亡的因素。
结论:入院时完成VTE风险评估超过国家标准(大于95%)。对于近四分之一的HA-DVT患者,规定的血栓预防剂量不适合体重.在5例HA-DVT中,没有明确的理由而省略了血栓预防.HA-DVT通常影响临床上最脆弱的患者,并与高死亡率相关。
BACKGROUND: Hospital-acquired
venous thromboembolism (HA-VTE) is defined as cases of
venous thromboembolism (VTE) that occur in a hospital and within ninety days of a hospital admission. Deep vein thromboses (DVTs) most commonly occur within the deep veins of the pelvis and legs. If the thrombus dislodges and travels to the lungs, it can result in a pulmonary embolus (PE). VTE is associated with significant morbidity and mortality, accounting for almost 10% of all hospital deaths. If risk factors are correctly identified and VTE prophylaxis is prescribed, VTE can be a preventable condition. In 2010, NHS England launched The National
Venous Thromboembolism Prevention Programme. This included NICE guidance, and a VTE risk assessment tool, which must be completed for at least 95% of patients on admission. The National Thrombosis Survey, published by Thrombosis UK, studied how this program was implemented locally, and audited HA-VTE prevention strategies nationally.
OBJECTIVE: Using the Thrombosis Survey and NICE guidance as an aide, this
study collects data about hospital-acquired DVT (HA-DVT) at the Queen Elizabeth Hospital in Gateshead (QEH) and aims to: 1. Identify cases of HA-DVT and understand the clinical circumstances surrounding these cases 2. Assess the quality of VTE preventative measures at QEH 3. Outline potential improvement in reducing the incidence of HA-VTE at this hospital Methods: This retrospective cohort
study used electronic records to identify all cases of DVT between April 2019 and April 2022 at QEH. Cases of HA-DVT were defined as: a positive ultrasound doppler report and either the case occurring in the 90 days following an inpatient stay, or beyond two days into an admission. For these cases of HA-DVT, we recorded the: reason for admission; admitting specialty; presence of an underlying active cancer and deaths occurring within 90 days of diagnosis. We assessed the quality of VTE preventative measures, by recording the: completion of VTE risk assessments; prescription of weight-adjusted pharmacological VTE prophylaxis and provision of VTE prophylaxis on discharge. For HA-DVT cases occurring within 90 days of an inpatient stay, the preventative measures were assessed on the original admission. Electronic records were used to record the completion rate of the National VTE risk assessment tool for all inpatients during this time frame.
RESULTS: The VTE risk assessment tool was completed for 98.5% of all admissions. One hundred and thirty-five cases of HA-DVT were identified between April 2019 and April 2022. Sixteen patients with HA-DVT did not have VTE prophylaxis prescribed on admission. Eleven of these patients had a clearly documented reason why anticoagulation was avoided. In HA-DVT cases where pharmacological VTE prophylaxis was prescribed, 23% were prescribed an inappropriate dose for their weight. If anticoagulation was required on discharge, this was prescribed appropriately in 94% of cases. About 31% of the patients with HA-DVT had an underlying active malignancy. Thirty-nine patients died within 90 days of the DVT being diagnosed; in only 1 case was VTE thought to be a contributing factor to death.
CONCLUSIONS: The hospital exceeded the national standard of VTE risk assessment completion on admission (greater than 95%). For almost a quarter of patients with HA-DVT, the dose of thromboprophylaxis prescribed was not appropriate for weight. In five cases of HA-DVT, thromboprophylaxis was omitted with no clear justification. HA-DVT often affects the most clinically vulnerable patients and is associated with a high mortality.