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Correspondence |

Linking Processes and Outcomes:  A Key Strategy to Prevent and Report Harm From Venous Thromboembolism in Surgical Patients

Jonathan K. Aboagye, MBChB, MPH; Brandyn D. Lau, MPH, CPH; Eric B. Schneider, PhD; Michael B. Streiff, MD; Elliott R. Haut, MD
JAMA Surg. 2013;148(3):299-300. doi:10.1001/jamasurg.2013.1400.
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Venous thromboembolism (VTE) prophylaxis for surgical patients cannot be overemphasized. The Joint Commission, the American College of Surgeons, the American College of Chest Physicians, the Agency for Healthcare Research and Quality, and others advocate risk-appropriate prophylaxis for all surgical patients. Despite strong evidence supporting its efficacy, VTE prophylaxis is frequently underutilized, with reported rates of 32% to 59%.1,2 Although VTE has been labeled a “never event” by some organizations, it is clear that many hospital-acquired events are not preventable.3,4 A newly suggested definition of preventable harm linking the process of VTE prophylaxis to outcomes3 has been adopted as a Clinical Quality Measure by the Centers for Medicare and Medicaid Services in their “meaningful use” incentive program. We sought to link process and outcome data from disparate sources in order to determine the proportions of surgical patients prescribed risk-appropriate VTE prophylaxis who developed potentially preventable VTE.

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Figure. The percentage of patients with postoperative venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) who were prescribed risk-appropriate VTE prophylaxis compared with those who were not. The vast majority of VTE events occurred in patients prescribed risk-appropriate prophylaxis.

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