Post-discharge hospital-associated venous thromboembolism.

Background: Hospital-associated venous thromboembolism (HA-VTE) morbidity and mortality has potentially been underestimated to date. Our centre is a tertiary, multi-campus health service which manages 265,000 admissions a year. Our VTE committee, comprising haematologists and other physicians, quality service representatives and pharmacists, routinely audits inpatient VTE (IP-VTE) for potential preventability against VTE prophylaxis guidelines. Over the study period, 81 IP-VTE were reviewed with 23% deemed potentially preventable however post-discharge VTE (PD-VTE) is not routinely captured. This is where VTE, presumably because of the index admission, is diagnosed after discharge, leading to re-admission. Aim(s): To compare the incidence of PD-VTE against IP-VTE and review PD-VTE characteristics, adherence to VTE prophylaxis guidelines and potential preventability. Method(s): A retrospective audit of ICD-10 Australian Modification discharge coding for lower limb deep vein thrombosis (LLDVT) and pulmonary embolism (PE) in adults between January 2018 and May 2019 at Monash Health. Cases were filtered for criteria such as presence of new, objectively confirmed, symptomatic VTE within 90 days of an index admission greater than 48 hours (Figure 1). Our VTE committee reviewed all eligible cases. Result(s): 948 encounters had VTE discharge coding. Of these, 891 were excluded with 57 eligible patients (Figure 1 and Table 1). Median age was 71 years (range, 26 to 92) and 32% with active cancer. Most index admissions were medical (61%) with a median of 19 days between admissions (range 2-86). VTE prophylaxis during the index admission was concordant with guidelines in 51%. Non-adherence included delayed prescription (5%), interruptions (23%), none (14%) and inadequate prescriptions (e.g. inappropriately dose-reduced enoxaparin 7%). Overall, VTE prophylaxis adherence was 68% with 35% VTE events deemed potentially preventable. There were no deaths from PD-VTE. Conclusion(s): O