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VTE PREVENTION UPDATE, WA (May 2010)

VTE PREVENTION UPDATE, WA (May 2010). Dr Helen van Gessel Office of Safety and Quality Luke Slawomirski Performance Activity & Quality Division . Delivering a Healthy WA. Safety and Quality Investment for Reform (SQuIRe) Program. Since 2006/07 $8M each year across WA Health

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VTE PREVENTION UPDATE, WA (May 2010)

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  1. VTE PREVENTION UPDATE, WA (May 2010) Dr Helen van Gessel Office of Safety and Quality Luke Slawomirski Performance Activity & Quality Division Delivering a Healthy WA

  2. Safety and Quality Investment for Reform (SQuIRe) Program • Since 2006/07 $8M each year across WA Health • 8 quasi-collaboratives addressing priority clinical practice improvement areas • IHI “bundles”, process improvement focus • Central OSQ department “scaffolding” • Not voluntary • Area Health Services (x4) determine resource allocation and implementation www.safetyandquality.health.wa.gov.au/squire/index.cfm

  3. SQuIRe VTE prevention • AIM • prevent VTE by performing risk assessment and correct prophylaxis (based on VTE Working Gp evidence summary – NB no formal state policy) • PROCESSES TO MEASURE AND IMPROVE • % patients risk assessment • % patients at risk receiving correct prophylaxis • Aligned with QUM indicator defn and sampling method • Suggested initial focus surgical patients

  4. Mid 2009 progress Estimated coverage 20% inpatients ; All hospitals have “VTE team”; Moves to sustainable process monitoring; Range of achievement

  5. 2010 aim – generate a “sense of urgency” • Visit by NHS experts February 2010 • Created WA VTE Prevention Network -3 meetings, evolving interprofessional community of practice • “bring outside in” (Kotter) • Share ideas, experiences, learnings • Generate stories and new ideas • Generate data and talk about it in a meaningful way

  6. Ideas progressing / testing • NIMC risk assessment and mechanical prophylaxis prescription incorporation • “signal” event investigation • State VTE prevention policy • State risk assessment tool • Craft group – specific prophylaxis guidelines ?via Clinical Networks / professional • Investigating value of coded data • Talking to RFDS for country patient transfer diagnoses

  7. Estimating Iatrogenic VTE Burden WA • UK12 000 000 adult admissions; 311 000 inpatient VTE in untreated pts; 124 400 deaths/yr in untreated pts (UK Parliamentary Report) • WA 400 000 adult admissions; 10 366 inpatient VTE in untreated pts; 4 146 deaths/yr in untreated pts • Est. 25 VTE untreated pts / 1000 separations

  8. Iatrogenic VTE Incidence - Literature • Gallagher et al (2009): 2.57 cases / 1000 CWShttp://qshc.bmj.com/content/18/5/408.full • Leibson et al (2008): 2.59 / 1000 ‘encounters’ http://journals.lww.com/lww-medicalcare/Abstract/2008/02000/Identifying_In_Hospital_Venous_Thromboembolism.5.aspx

  9. VTE Incidence Data WA Request to Epidemiology Branch for 3 years’ VTE morbidity and mortality data • ICD-10-AM codes (based Access Economics study 2008) • COF (c-prefix) not used (WA: since July 2008) • Aims: • Gauge extent of incidence and burden – ‘URGENCY’ • Validate VTE coding sensitivity & specificity (case note r/v, radiology, RFDS) • Calculate extended LOS and additional cost of VTE

  10. Codes (preliminary list)

  11. Preliminary Administrative Data Extract • WA Area Health Service; July 2009 – March 2010 • Total separations ~ 147,000 • ICD-10-AM codes from prev. slide • COF* 1 & 2 = 832 cases (5.6 per 1000 separations) • Est. 50% healthcare associated = 416(2.8 / 1000 seps) • COF 1 only = 107 cases * see next 2 slides for definitions

  12. Condition onset Flag (COF) http://meteor.aihw.gov.au/content/index.phtml/itemId/354816 COF 1 • Condition with onset during the episode of admitted patient care • a condition which arises during the episode of admitted patient care and would not have been present on admission • Includes: • Conditions resulting from misadventure during medical or surgical care during the episode of admitted patient care. • Abnormal reactions to, or later complication of, surgical or medical care arising during the episode of admitted patient care. • Conditions arising during the episode of admitted patient care not related to surgical or medical care (for example, pneumonia).

  13. COF 2 • Condition not noted as arising during the episode of admitted patient care • a condition present on admission such as the presenting problem, a comorbidity, chronic disease or disease status.  • a previously existing condition not diagnosed until the episode of admitted patient care. • Includes: • In the case of neonates, the conditions present at birth. • A previously existing condition that is exacerbated during the episode of admitted patient care. • Conditions that are suspected at the time of admission and subsequently confirmed during the episode of admitted patient care. • Conditions that were not diagnosed at the time of admission but clearly did not develop after admission (for example malignant neoplasm). • Conditions where the onset relative to the beginning of the episode of admitted patient care is unclear or unknown.

  14. COF 1 & 2 dataset (n=832)

  15. Follow-up work to assess utility of admin data sources • Larger data set pending • Case note review validation • Sample of code – positive and code-negative records

  16. COF 1 dataset (n=107)

  17. COF 1 dataset (n=107)

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