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Hospital readmission for venous thromboembolism among postoperative patients may signal quality of care problems

Patients who are hospitalized for surgery are particularly susceptible to venous thromboembolism (VTE, a blocked blood vessel due to a blood clot, usually in the leg), due to the trauma of surgery and immobility afterwards. The Agency for Healthcare Research and Quality includes VTE as one of a group of 20 patient safety indicators (PSIs), which are indicators of complications of care or quality of care problems.

In the case of VTE, this might mean that the staff did not mobilize the patient early or provide compression to the legs to prevent blood pooling and clotting after surgery. VTE may occur postoperatively during the index surgical admission or after the patient has been discharged.

AHRQ defined its PSI for VTE as surgical cases with a secondary diagnosis of VTE. Short-term readmissions were excluded because many State administrative databases are unable to track readmissions. AHRQ PSIs were designed to allow comparison of rates across multiple States, meaning the data may be incomplete or inaccurate if short-term readmissions were to be included. For example, a recent AHRQ-supported study (HS11880) found an additional 1,059 cases of VTE when surgical patients with a short-term readmission for VTE were identified.

Short-term readmissions for VTE represent potentially important cases to capture when monitoring adverse events that may be connected to medical errors, note Wendy E. Weller, Ph.D., and colleagues, of the University at Albany School of Public Health. They used New York hospital inpatient data to identify patients meeting the AHRQ VTE PSI definition (surgical cases with a secondary diagnosis of pulmonary embolism or DVT) and those readmitted with a VTE principal diagnosis within 30 days of a prior hospitalization for surgery. A total of 4,906 cases in New York met the AHRQ definition in 2001. However, an additional 1,059 cases of VTE were found when surgical patients readmitted to the hospital within 30 days were considered.

These findings underscore the need to develop data systems that can track patients across multiple admissions for the purpose of identifying complications that result in short-term readmissions, note the researchers. They call for future research to explore the possibility of assessing other AHRQ PSIs, such as infections due to medical care, using linked data sets.

More details are in "Readmissions for venous thromboembolism: Expanding the definition of patient safety indicators," by Dr. Weller, Brian K. Gallagher, M.D., Liyi Cen, M.S., and Edward L. Hannan, Ph.D., in the September 2004 Joint Commission Journal on Quality and Safety 30(9), pp. 497-504.

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