Inaccuracies of Venous Thromboembolism Risk Assessment and Prevention Practices Among Medically Ill Patients Open Access

• VTE risk assessments completed by admitting providers are often inaccurate, leading to inappropriate VTE prevention and development of VTE

• Reduced mobility is a major VTE risk factor frequently misjudged on admission, and should be evaluated throughout hospitalization

Venous thromboembolism (VTE) is a common cause of preventable harm among hospitalized, medically ill patients. The purpose of this study is to evaluate the accuracy of Padua VTE risk assessments, VTE prevention practices, and outcomes. In this retrospective analysis of consecutively hospitalized, medically ill patients at The Johns Hopkins Hospital from January 1 through April 30, 2019, a hematologist subject matter expert (SME) retrospectively completed a Padua VTE risk assessment for every patient. Results were compared with risk assessments completed by the admitting provider. The primary outcome was agreement between the SME and admitting provider on overall VTE risk. Secondary outcomes included agreement on VTE risk factors, risk-appropriate VTE prophylaxis prescription and administration, and VTE outcomes. Of 4,021 patients included, agreement between admitting providers and the SME on overall VTE risk was 65.3%. The SME identified 1,156 (28.7%) patients as high risk who were categorized on admission as low risk. Risk factors with the lowest agreement were reduced mobility and acute infection. 2,141 (53.2%) patients were prescribed appropriate VTE prophylaxis. Thirty-six patients developed in-hospital VTE, including 21 who had been misclassified as low risk. Significantly more doses of prescribed VTE prophylaxis were not administered among patients who developed VTE (19.6% vs. 15.2%, p=0.007). Inaccurate VTE risk assessment leads to inappropriate VTE prevention practices and preventable VTE. Leveraging existing, structured data to autopopulate VTE risk assessments can assist providers in improving accuracy. Quantitative measures of patient mobility should be incorporated into VTE risk assessment.