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Measure Information Form
Version 2010A1


**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**

Measure Information Form

Measure Set: Surgical Care Improvement Project (SCIP)

Set Measure ID: SCIP-venous-thromboembolism-2

Performance Measure Name: Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery

Description: Surgery patients who received appropriate venous thromboembolism (VTE) prophylaxis within 24 hours prior to Surgical Incision Time to 24 hours after Surgery End Time.

Rationale: There are over 30 million surgeries performed in the United States each year. Despite the evidence that VTE is one of the most common postoperative complications and prophylaxis is the most effective strategy to reduce morbidity and mortality, it is often underused. The frequency of venous thromboembolism (VTE), that includes deep vein thrombosis and pulmonary embolism, is related to the type and duration of surgery, patient risk factors, duration and extent of postoperative immobilization, and use or nonuse of prophylaxis. According to Heit et al, 2000, surgery was associated with over a twenty-fold increase in the odds of being diagnosed with VTE. Studies have shown that appropriately used thromboprophylaxis has a positive risk/benefit ratio and is cost effective. Prophylaxis recommendations for this measure are based on selected surgical procedures from the 2004 American College of Chest Physicians guidelines.

Timing of prophylaxis is based on the type of procedure, prophylaxis selection, and clinical judgment regarding the impact of patient risk factors. The optimal start of pharmacologic prophylaxis in surgical patients varies and must be balanced with the efficacy-versus-bleeding potential. Due to the inherent variability related to the initiation of prophylaxis for surgical procedures, 24 hours prior to surgery to 24 hours post surgery was recommended by consensus of the SCIP Technical Expert Panel in order to establish a timeframe that would encompass most procedures.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Surgery patients who received appropriate venous thromboembolism (VTE) prophylaxis within 24 hours prior to Surgical Incision Time to 24 hours after Surgery End Time.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: All selected surgery patients

Included Populations:
  • ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.10 for ICD-9-CM codes)
    AND
  • ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.17-5.24 for ICD-9-CM codes)

Excluded Populations:

  • Patients less than 18 years of age
  • Patients who have a length of Stay >120 days
  • Burn patients (as defined in Appendix A, Table 5.14 for ICD-9-CM codes)
  • Patients with procedures performed entirely by laparoscope
  • Patients enrolled in clinical trials
  • Patients who are on warfarin prior to admission
  • Patients whose ICD-9-CM principal procedure occurred prior to the date of admission
  • Patients whose total surgery time is less than or equal to 60 minutes
  • Patients who stayed less than or equal to 3 calendar days postoperatively
  • Patients with contraindications to both mechanical and pharmacological prophylaxis
  • Patients who did not receive VTE Prophylaxis (as defined in the Data Dictionary)

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: Measure rates for SCIP-VTE-2 should be analyzed in conjunction with SCIP-VTE-1 in order to identify focus areas for quality improvement. Low measure rates may indicate the need for staff education or evaluation of organizational factors and processes of care. Note that rates for SCIP-VTE- 2 may be lower than those for SCIP-VTE-1 as a result of more stringent criteria. SCIP-VTE-2 requires documentation that prophylaxis was ordered and actually started, whereas SCIP-VTE-1 requires only documentation of an order.

Sampling: Yes. For additional information see Sampling Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

  • Chapter 31 of Making Healthcare Safer: A Critical Analysis of Patient Safety Practices. Prepared for Agency for Healthcare Research and Quality, Contract No. 290-97-0013. Prevention of Venous Thromboembolism. PMID: 00000.
  • Anderson FA, Wheeler HB, Goldberg RJ, et al. Physician practices in the prevention of VTE. Ann Intern Med. 1991;115-591-595. PMID: 1892330.
  • Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:338S-400S. PMID: 15383478.
  • Stratton MA, Anderson FA, Bussey HI, Caprini J. Prevention of venous thromboembolism: adherence to the 1995 American College of Chest Physicians Consensus Guidelines for Surgical Patients. Arch Intern Med. 2000;160:334-3. PMID: 10668835.
  • Amarigiri SV, Lees TA. Elastic compression stockings for prevention of deep vein thrombosis. The Cochrane Library, Issue 1, 2001. PMID: 10908501.
  • Iorio A, Agnelli G. Low-molecular-weight and unfractionated heparin for prevention of venous thromboembolism in neurosurgery: a meta-analysis. Arch Intern Med. 2000;160:2327-2332. PMID: 10927730.
  • Goldhaber SZ, Dunn K, MacDougall RC. New onset of venous thromboembolism among hospitalized patients at Brigham and Women's Hospital is caused more often by prophylaxis failure than by withholding treatment. Chest. 000;118:1680-1684. PMID: 11115458.
  • O’Donnell M, Weitz JI. Thromboprophylaxis in surgical patients. Can J Surg. 2003; 46(2): 129-135. PMID: 12691354.
  • Janku GV, Paiement GD, Green HD. Prevention of venous thromboembolism in orthopaedics in the United States. Clin Ortho & Related Research. 1996:313-321. PMID: 8998892.
  • Koch A, Bouges S, Ziegler S, et al. Low molecular weight heparin and infractionated heparin in thrombosis prophylaxis after major surgical intervention: update of previous meta-analyses. Br J Surg. 1997;84:750-759. PMID: 9189079.
  • Palmer AJ, Schramm W, Kirchhof B, et al. Low molecular weight heparin and unfractionated heparin for prevention of thrombo-embolism in general surgery: a meta-analysis of randomised clinical trials. Haemostasis. 1997;27:65-74. PMID: 9212354.
  • Bratzler DW, Raskob GE, Murray CK, et al. Underuse of venous thromboembolism prophylaxis for general surgery patients: physician practices in the community hospital setting. Arch Intern Med. 1998;158:1909-1912. PMID: 9759687.
  • Vanek VW. Meta-analysis of effectiveness of intermittent pneumatic compression devices with a comparison of thigh-high to knee-high sleeves. American Surgeon. 1998;64:1050-1058. PMID: 9798767.
  • Hull RD, Brant RF, Pineo GF, et al. Preoperative vs postoperative initiation of low-molecular-weight heparin prophylaxis against venous thromboembolism in patients undergoing elective hip replacement. Arch Intern Med. 1999;159:137-141. PMID: 9927095.
  • Raskob GE, Hirsh J. Controversies in timing of the first dose of anticoagulant prophylaxis against venous thromboembolism after major orthopedic surgery. Chest. 2003 Dec;124(6 Suppl):379S-385S.
  • Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ, III. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000;160:809-815.

Measure Algorithm:

Attach file

Related Topics
VTE Prophylaxis Options for Surgery

Measure Information Form SCIP-venous-thromboembolism-2
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)