In what could be a model for other surgical facilities, a coordinated, multi-faceted, 2-year effort to reduce blood clots at Boston (Mass.) Medical Center succeeded in reducing deep venous thromboses (DVT) by 84% and pulmonary emboli by 55%, the American College of Surgeons reports.
Along with urging patients to walk 3 times a day, including on the day of surgery, if possible, the program incorporated an analysis of risk factors such as age, obesity, smoking, bed confinement, personal and family history, and length of operation.
Along with the need for early mobilization, electronic physician orders specified a requirement to score patient risk, to provide appropriate preventive treatment based on risk scores and, for high-risk patients, continuing treatment once patients were home. Risk-based prophylaxis included inflatable pressure boots and low doses of blood thinners. Patients were also educated about the importance of preventing blood clots.
Comparing the 2 years before the program was implemented with the 2 years that followed, the frequency of DVT declined from 1.9% of 1,569 patients to 0.3% of 1,323 patients, and the frequency of pulmonary emboli dropped from 1.1% of 1,569 patients to 0.5% of 1,323 patients.