title: Comprehensive VTE prevention program incorporating mandatory risk assessment reduces the incidence of hospital-associated thrombosis.
abstract: BACKGROUND
  VTE is a common complication of hospitalization and is associated with significant morbidity and mortality. The use of appropriate thromboprophylaxis can significantly reduce the risk of VTE but remains underutilized. In England, a comprehensive approach to VTE prevention was launched in 2010. This study aimed to evaluate the impact of the implementation of the national program in a single center.
  
  
  METHODS
  A prospective quality improvement program was established at King's College Hospital NHS Foundation Trust in 2010. The multidisciplinary thrombosis team launched mandatory documented VTE risk assessment and updated thromboprophylaxis guidance. Root cause analysis of hospital-associated thrombosis (HAT) was implemented to identify system failures, enable outcome measurement, and facilitate learning to improve VTE prevention practice. The key outcomes were the incidence of HAT and the proportion of events preventable with appropriate thromboprophylaxis.
  
  
  RESULTS
  Documented VTE risk assessment improved from &lt;40% to &gt; 90% in the first 9 months. Four hundred twenty-five episodes of HAT were identified over 2 years. A significant reduction in the incidence of HAT was observed following sustained achievement of 90% risk assessment (risk ratio, 0.88; 95% CI, 0.74-0.98; P = .014). The proportion of HAT attributable to inadequate thromboprophylaxis fell significantly from 37.5% to 22.4% (P = .005).
  
  
  CONCLUSIONS
  Mandatory VTE risk assessment can significantly reduce preventable HAT and thereby improve patient safety.
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, England. Electronic address: lara.roberts@nhs.net.
authors.forename: Lara N
authors.initials: LN
authors.lastname: Roberts
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, England.
authors.forename: Gayle
authors.initials: G
authors.lastname: Porter
authors.affiliation: Department of Information and Communication Technology, King's College Hospital NHS Foundation Trust, London, England; Division of Asthma, Allergy and Lung Biology, King's College Hospital NHS Foundation Trust, London, England.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Barker
authors.affiliation: Department of Information and Communication Technology, King's College Hospital NHS Foundation Trust, London, England.
authors.forename: Richard
authors.initials: R
authors.lastname: Yorke
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, England.
authors.forename: Lynda
authors.initials: L
authors.lastname: Bonner
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, England.
authors.forename: Raj K
authors.initials: RK
authors.lastname: Patel
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, England.
authors.forename: Roopen
authors.initials: R
authors.lastname: Arya
mesh_terms: D006760:Hospitalization; D006801:Humans; D015994:Incidence; D011446:Prospective Studies; D058996:Quality Improvement; D018570:Risk Assessment; D013927:Thrombosis / Q000453:epidemiology* / Q000517:prevention & control*; D054556:Venous Thromboembolism / Q000517:prevention & control