VTE: Clinical and System Reviews, Incident Analyses

Given the broad range of potential causes of hospital associated VTE, clinical and system reviews should be conducted to identify latent causes and determine appropriate recommendations.

Occurrences of harm are complex with many contributing factors. Organizations need to:

1. Measure and monitor the types and frequency of these occurrences.
2. Use appropriate analytical methods to understand the contributing factors.
3. Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.
4. Have mechanisms in place to mitigate consequences of harm when it occurs.

To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the Hospital Harm Improvement Resources Introduction.  

If your review reveals that your cases of VTE are linked to specific processes or procedures, you may find these resources helpful:

• American Society of Clinical Oncology www.asco.org
  • Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer Update https://www.asco.org/research-guidelines/quality-guidelines/guidelines/supportive-care-and-treatment-related-issues#/9911
• American Society of Hematology https://www.hematology.org/
  • 2019 Guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients https://ashpublications.org/bloodadvances/article/3/23/3898/429211/American-Society-of-Hematology-2019-guidelines-for
  • 2018 Guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients (Schünemann) https://ashpublications.org/bloodadvances/article/2/22/3198/16115/American-Society-of-Hematology-2018-guidelines-for\
  • 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy (Bates) https://ashpublications.org/bloodadvances/article/2/22/3317/16094/American-Society-of-Hematology-2018-guidelines-for?searchresult=1
• CHEST – American College of Chest Physicians www.chestnet.org
  • Antithrombotic Therapy and Prevention of Thrombosis (9^th Edition), Published: February 2012 Prevention of VTE in Nonsurgical Patients https://journal.chestnet.org/article/S0012-3692(12)60124-X/fulltext?_ga=2.21455602.810240998.1611603389-2133843351.1611603389
    • Prevention of VTE in Nonsurgical Patients https://journal.chestnet.org/article/S0012-3692(12)60124-X/fulltext?_ga=2.21455602.810240998.1611603389-2133843351.1611603389
    • Prevention of VTE in Nonorthopedic Surgical Patients https://journal.chestnet.org/article/S0012-3692(12)60125-1/fulltext?_ga=2.34014952.810240998.1611603389-2133843351.1611603389
    • Prevention of VTE in Orthopedic Surgery Patients https://journal.chestnet.org/article/S0012-3692(12)60126-3/fulltext?_ga=2.191914723.810240998.1611603389-2133843351.1611603389
    • Prevention, Diagnosis, and Treatment of VTE in Patients with Coronavirus Disease 2019 CHEST (chestnet.org)
• International Society on Thrombosis and Haemostasis
  International Society on Thrombosis and Haemostasis, Inc. (isth.org)
  • Full list of Published Guidance - International Society on Thrombosis and Haemostasis, Inc. (isth.org)
  • Spyropoulos, A.C., Levy, J.H., Ageno, W., Connors, J.M., Hunt, B.J., Iba, T., Levi, M., Samama, C.M., Thachil, J., Giannis, D., Douketis, J.D. and (2020), Scientific and Standardization Committee Communication: Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients with COVID‐19. J Thromb Haemost. Author Accepted Manuscript. 
• Journal of Clinical Medicine https://www.mdpi.com/journal/jcm
  • Nicholson M, Chan N, Bhagirath V, Ginsberg, J. Prevention of Venous Thromboembolism in 2020 and Beyond. J. Clin. Med. 2020, 9, 2467-2494. https://www.mdpi.com/2077-0383/9/8/2467
• Plos One https://journals.plos.org/plosone/
  • A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207410
• Society of Obstetricians and Gynaecologists of Canada www.sogc.org
  • Clinical Practice Guidelines: Venous thromboembolism and antithrombotic therapy in pregnancy. J Obstet Gynaecol Can. 2014; 36 (6): 527–553. https://www.jogc.com/article/S1701-2163(15)30569-7/fulltext
• Stop the Clot. https://www.stoptheclot.org/
• The Lancet Oncology https://www.thelancet.com/journals/lanonc/home
  • 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer https://www.sciencedirect.com/science/article/pii/S1470204519303365?casa_token=wR071dAWhlkAAAAA:IbnuYnSXaD97RZBGMYSFzAJK90a0l9H5EPGD4mwzgakl1qcvD4ali4tXgdHPr0bkc3jRFbxkZD4
• Thrombosis Canada. http://thrombosiscanada.ca/
• World Thrombosis Day. http://www.worldthrombosisday.org/