Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant and preventable complication of hospitalization. Affecting up to 600,000 patients annually, VTE is a leading cause of preventable hospital death, post-surgical readmissions, and increased length of stay.
To address this growing issue, the Centers for Medicare & Medicaid Services (CMS) has established VTE-related standards as part of the Hospital-Acquired Condition (HAC) Reduction Program. This program utilizes electronic clinical quality measures (eCQMs) to track and report VTE prophylaxis and hospital-acquired VTE (HA-VTE) rates. Hospitals in the lowest-performing quartile face payment reductions, impacting their reimbursements.
Key CMS VTE-related measures include:
- CMS108v11: Venous Thromboembolism Prophylaxis (VTE-1): This measure assesses whether patients receive VTE prophylaxis or have documentation of why prophylaxis was not given
- CMS190v14 Intensive Care Unit Venous Thromboembolism Prophylaxis (VTE-2): This measure focuses on patients in intensive care units who receive VTE prophylaxis or have documentation of why no VTE prophylaxis was given.
Given the significant risks and consequences of VTE, effective prevention strategies are essential.
VTE Prophylaxis Methods
Almost all hospitalized patients have at least one risk factor for VTE, and approximately 40% have three or more risk factors. One crucial intervention to reduce the risk of HA-VTE is the use of prophylaxis.
There are two primary categories of VTE prophylaxis:
- Pharmacological prophylaxis: Anticoagulant medications to inhibit blood clotting, such as Low Molecular Weight Heparins (LMWHs).
- Mechanical prophylaxis: Techniques to promote venous return and reduce blood clot risk, such as intermittent pneumatic compression (IPC) devices. These devices often utilize sleeves or cuffs that apply external compression to increase blood flow in the deep veins, moving it towards the heart and preventing pooling.
Mechanical prophylaxis is an integral part of VTE prevention and is recommended across nearly all risk categories for patients with average or high bleeding risk. It is particularly beneficial when pharmacological options are contraindicated or in patients at mid-to-low risk who may not require medication. A combination of both mechanical and pharmacological interventions can also effectively reduce the risk of VTE in some cases.
The Impact of Mobility
Prolonged bed rest and inactivity can lead to hospital-acquired immobility, which significantly increases the risk of VTE and other serious complications. In fact, patients may spend up to 95% of their hospital stay in bed, highlighting the need for early and progressive mobilization to help prevent HA-VTE.
Early mobilization is associated with improved functional outcomes, reduced hospital costs, and decreased length of stay. Mobilization efforts can include:
- Ambulation
- Periodic changes in position, such as turning or sitting up in bed
- Dangling legs at the side of the bed
- Moving to a chair
By prioritizing early and progressive patient mobilization, healthcare providers can help mitigate the effects of hospital-acquired immobility and reduce the risk of VTE and other complications. Encouraging patients to mobilize helps to improve their physical function, reduce hospital-acquired conditions such as blood clots, shorten hospital stays, and improve their physical and neurocognitive outcomes.
Overcoming Barriers to Effective VTE Prevention
Despite the effectiveness of VTE prophylaxis, compliance with recommended utilization in both medical and surgical patients is suboptimal or not at all. Up to 70% of VTE cases among hospitalized patients are preventable, yet fewer than half receive adequate preventive treatment. Many factors can contribute to this – patients often experience discomfort, sleep disturbance, lack of education, or don’t want to be tethered to the bed more than they already might be.
How RF Health is Paving the Way for Improved Patient Outcomes
In 2022, our team launched an innovative wearable mobile compression device, offering promising solutions to overcome the limitations of traditional IPC devices. The Movement And Compressions (MAC) System aims to promote safe mobility, increase compliance, and provide accurate data on wear time, patient orientation, and steps. By addressing the shortcomings of traditional IPC devices, these innovations can help enhance the effectiveness of VTE prevention strategies.
Key Features of the MAC System for Blood Clot Prevention
- Mobile Compressions: A true tubeless/cordless design allowing patients to mobilize without needing assistance unplugging/replugging from the device
- Data at Your Fingertips: MAC provides real-time data on the screen to show a patient’s mobility, wear time, and compliance over a 48-hour period, allowing staff to make actionable decisions and see how a patient is progressing. *Additional data-reporting options are available, including EMR integration capability
- Patient Comfort: MAC is approximately one-third the size of current standard-of-care devices. It is a more lightweight, quiet, breathable option for compression therapy, helping to drive compliance.
- Dynamic Sizing: MAC’s adaptive fit responds to changes in calf circumference, ensuring the patient is consistently receiving the right amount of compression.
By leveraging innovations, including cordless and tubeless wearable mobile compression devices such as the MAC System, healthcare providers can improve patient outcomes, reduce the risk of VTE, and enhance the overall quality of care.
Conclusion
As CMS continues to track and report VTE prophylaxis and hospital-acquired VTE rates through its Hospital-Acquired Condition (HAC) Reduction Program, healthcare organizations must prioritize effective VTE prevention strategies to avoid payment reductions and improve patient outcomes. Utilizing innovative mechanical prophylaxis technologies, early mobilization, and other evidence-based strategies enables healthcare providers to deliver preventative care that addresses each patient’s unique needs while effectively meeting CMS standards.