Leading Other Centers in Preventing Blood Clots in Hospital Patients

UCSD is setting a national standard for protecting hospital patients from the risk of developing blood clots, thanks to a dedicated effort of the Division of Hospital Medicine.

During any hospital stay, a patient has a significant risk of developing a blood clot in a limb (deep vein thrombosis, or DVT) that may travel to the lung (pulmonary embolism). Pulmonary embolism is considered the leading cause of preventable death in hospitalized patients.

The overall term for this phenomenon is hospital-acquired venous thromboembolism (VTE).

Careful measures can reduce the risk of hospital-acquired VTE substantially. These include activity, support hose, sequential compression devices, and blood-thinning medications such as heparin.

On average, hospitals across the nation are offering adequate blood clot prevention measures to about half of the patients who stay in the hospital.

That was UCSD’s level of performance before the Division of Hospital Medicine started a “Partners in Patient Safety” project funded by the Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health and Human Services.

Now, just two years later, over 95% of UCSD inpatients are receiving adequate clot prevention regimens, setting a new national benchmark. The number of UCSD patients who develop hospital-acquired clots has dropped by about 35%.

Heading the UCSD blood clot prevention project is Dr. Greg Maynard, Chief of the Division of Hospital Medicine and a national leader in the field of patient safety.

The two-year study is titled “Optimal Prevention of Hospital Acquired Venous Thromboembolism” under AHRQ grant 1U18HS015826-01. Its purpose is to find the best ways to prevent hospital-acquired blood clots, and build tool kits that enable others to do the same.

Other major contributors include Dr. Tim Morris, Associate Professor of Clinical Medicine and Director of Pulmonary Clinical Programs at the UCSD Medical Center – Hillcrest) and pharmacists Robert Schoenhaus, Pharm.D., and Douglas Humber, Pharm.D.

Dr. Maynard and his coworkers have developed a VTE prevention protocol, tested it, found it highly successful, and published it for other centers to use.

Under the new protocol, every new or transferred patient is quickly evaluated for his or her risk of developing a blood clot, and the appropriate measures are ordered. Nurses act as another line of defense, and can help identify patients who might otherwise have slipped between the cracks as their bleeding risk or clot risk changed.

Whether the risk is low, average, or high depends on a patient’s age, medical condition, reason for hospitalization, and other factors.

The task called for Dr. Maynard and his colleagues to develop a quick, accurate, reliable way for nurses or other medical staff to screen each patient for blood clot risk. He said existing methods were discarded because they failed to be useful in actual practice.

“We needed a reliable tool that we could apply to any patient of any description in 10 seconds or less,” he said.

The tool kit is now housed at the Society of Hospital Medicine (SHM) website, where it is the centerpiece of a SHM VTE Prevention Collaborative involving 30 medical centers from all over the country.

About the VTE Prevention Collaborative, Dr. Maynard says, “We’re using tools, largely developed here, to help guide other medical centers through the process. We’re mentoring other hospitalists to be leaders in hospital improvement in general, not only as pertains to VTE.”

As part of the Collaborative, Dr. Maynard is one of two mentors who work with hospitalists around the country. By telephone and email, he advises hospitalists at about a dozen centers who download and use the patient care protocols he has helped to develop.

He sees this as part of the mission of hospital medicine. “We identify the best practices and try to build them into a protocol on the front line of use so that every patient is exposed to that treatment practice,” he says. “And we enable others beyond our local environment to do the same thing.”

Dr. Maynard has been a major figure in national efforts to improve the quality of inpatient care for many years. He is a leading member of the Society of Hospital Medicine, and has also worked nationally on inpatient management of diabetes and other common inpatient problems.

At UCSD, where he has headed the Division of Hospital Medicine since 2003, Dr. Maynard is Chairman of the Patient Safety Committee.

The UCSD Division of Hospital Medicine focuses on the special issues that affect the health and care of patients who are hospitalized at UCSD. Its mission is to improve the quality and safety of inpatient care.