1. The Health Roundtable 3-3c_HRT1215-Session_HANNAFORD_UNSW_NSW How many people received appropriate VTE prophylaxis? Presenter: Natalie Hannaford UNSW Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1

2. The Health Roundtable KEY PROBLEM  Approx 30,000 people are hospitalised due to VTE each year and about 2000 of those die (NHMRC 2009)  PE is responsible for about 10% of all hospital deaths (NHMRC, 2009)  The annual economic burden of VTE in Australia has been estimated to be as high as $21 Billion (Access Economics 2008)  An international audit of 70,000 patients, including Australia, found that only 50% of at-risk patients were receiving appropriate prophylaxis (Endorse study 2008; Cohen et al) 2

3. The Health Roundtable AIM OF THE STUDY  To translate the evidence contained in the guidelines to measurable clinical indicators  To determine how many Australian patients in our sample admitted to hospital during 2009 and 2010 received appropriate VTE prophylaxis. 3

4. The Health Roundtable Method  Developed 39 clinical indicators from the NHMRC 2009 VTE prophylaxis guidelines and the ANZWP VTE prevention 2007 guidelines  Patients admitted to hospital were risk assessed for VTE  Patients having a total hip replacement were prescribed graduated compression stockings  Ratified and endorsed by 3 clinical experts  Conducted a retrospective on site medical record review using a web based encrypted data collection tool  485 participants admitted to public and private hospitals in NSW and SA 4

5. The Health Roundtable RESULTS  Overall compliance - 58% (95%CI 53.3% - 63.0%)  Admitted patients risk assessed for VTE – 69%  Aggregated results  surgical cases prescribed appropriate medication – 39%  Hip replacement medication compliance - 55%  Knee replacement medication compliance – 49%  medical admissions prescribed appropriate medication – 46%  Cancer patients with active cancer or undergoing surgery (meds & dev) – 32% 5

6. The Health Roundtable RESULTS  Patients with a suspected DVT had appropriate tests- 84.6%  Patients with suspected PE had appropriate tests – 81%  Patients administered heparin therapy had it continued until the INR was therapeutic for 48 hours – 51.2% 6

7. The Health Roundtable LESSONS LEARNT  Overall compliance was less than adequate and surprising for some conditions (orthopaedic surgery).  Obvious that some hospitals had implemented formal VTE risk assessment tools into admission documentation, but many had no means of recording/assessing this.  Still a lot of work to be done in this area to increase compliance and to understand why it remains low. 7