Omitting DVT prophylaxis places facility at risk

Should you screen?

Managed care constraints require shorter hospital stays for many surgical procedures, and those early discharges are having a negative impact on proximal deep venous thrombosis (DVT) prevention. Be aware that neglecting to administer DVT prophylaxis not only places surgical patients at risk but can expose your facility to liability as well. The Harvard medical system in Cambridge, MA, has been involved in nearly $3 million in malpractice claims involving DVT or pulmonary embolism over the past 20 years.

Consider this scenario: A patient develops post-op DVT or pulmonary embolism following a surgery known to be high risk for thromboembolism. To protect herself and the hospital, the treating physician must demonstrate she administered a well-recognized form of prophylaxis. A prescription for graduated compression stockings following a high-risk surgery such as prostatectomy, for example, does not constitute an approved prophylaxis regimen.

IPRO, the federally designated peer review organization for New York State, recently analyzed Medicare charts from 132 hospitals and found that DVT is involved in more than 500,000 hospitalizations each year. Complications can include potentially fatal pulmonary embolism. The organization’s study demonstrated that only a little more than half of patients undergoing prostatectomy had received adequate DVT prophylaxis. A higher proportion of patients undergoing hip replacements received adequate preventive measures.

Screening compression ultrasonography before hospital discharge can detect some DVT and pulmonary embolism, yet two recent studies concluded that routine use of postarthroplasty screening wasn’t justified from a cost-effectiveness standpoint in that setting.1,2 One study disclosed that screening did not reduce the rate of thromboembolic complications. In the other, the incidence of DVT was only 3.6% among 102 asymptomatic patients. Both teams concluded that screening should be performed only in patients with limb edema or unexplained pulmonary signs.

References

1. Robinson KS, Anderson DR, Gross M, et al. Ultrasonographic screening before hospital discharge for deep venous thrombosis after arthroplasty: The Postarthroplasty screening study. Ann Intern Med 1997; 127:439-445.

2. Marik PE, Andrews L, Maini B. The incidence of deep venous thrombosis in ICU patients. Chest 1997; 111:661-664.