Retrospective study of radiologically confirmed hospital-acquired venous thromboembolic disease

Objective: To study hospital-acquired venous thromboembolic disease (HAVTED) and the relationship between its incidence and compliance with thromboprophylaxis protocols. Methods: For the past eight years, specialty-specific protocols for VTE prophylaxis have been in operation throughout this hospital. Patients developing radiologically proven VTE either as inpatients or within 12 weeks of discharge were identified from a register. Patients were categorized according to risk as per the Scottish Intercollegiate Guidelines Network (SIGN) guidelines. The use of pharmacological prophylaxis for VTE was recorded. Results: Over a period of 24 months, 98 patients had radiologically proven HAVTED. Of 44 categorized as high risk, 17 (39%) had received prophylaxis. Corresponding figures for 50 at medium risk and four at low risk were 16 (32%) and three (75%), respectively. The overall incidence of HAVTED averaged two per 1000 inpatient discharges varying between 0.2 in General Medicine and 6.6 in Trauma Orthopaedics. The mean additional cost of treating a case of HAVTED was estimated at £3,000. Conclusion:Audit of radiological investigations of VTE showed that 18% of all cases were hospital acquired. A hospital policy of thromboprophylaxis may reduce but does not eliminate HAVTED. A substantial proportion of patients with HAVTED had not received prophylaxis. The possibility of a further reduction in incidence of HAVTED with potential saving in morbidity, mortality and cost is highlighted. The implementation and efficacy of thromboprophylaxis protocols should be monitored.