feasibility study of the caprini risk scoring system dvt/pe management in canada's publicly...
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FEASIBILITY STUDY OF THE CAPRINI RISK SCORING SYSTEM
DVT/PE MANAGEMENT IN CANADA'S PUBLICLY FUNDED HEALTHCARE SYSTEM
Trevor GillPeter Doris MDAngela Tecson RN
Surrey Memorial Hospital
Located in Surrey, British Columbia, Canada
Close to 500 beds
Busiest ER in BC with over 93 000 visits per year
2010 ACS NSQIP Conference
Dr Joseph A Caprini’s presentation on DVT
Demonstrated efficacy of his risk scoring system
Can be contacted at [email protected]
DVT/PE in Our Hospital
Though our Hospital is in the “as expected” category we feel through better use of prophylaxis we can become “exemplary” while save the hospital money
Initial Review
After Dr Caprini’s presentation we investigated DVT/PE at SMH using NSQIP data
Examined O/E – was “as expected”
One “Moderate Risk” case, the rest “Highest” or “Higher Risk”
7/05-6/06 1/06-12/06 7/06-6/07 1/07-12/07 7/07-6/08 1/08-12/08 7/08-6/09 1/09/12/09
DVT PEO/E 0.2 0.35 L 0.75 0.58 0.37 0.9 0.74 0.48
Caprini Scoring System
Risk scoring system for calculating risk of post-op DVT/PE
Different risk criteria count for different points
Patient assigned to risk group based on score
What does it cost?DVT/PE costs us $5393 & $7631 respectively*
Large percentage patients in highest risk category
Too expensive to give them all 30 day prophylaxis
Goals of study:To identify a cut-off Caprini score for very high risk
patients.Use data to demonstrate high risk patients require
30 day prophylaxis
*Before Physician Wages – From the Canadian Institute for Health Information
Retrospective Analysis
To further support implementation of Caprini we conducted a retrospective study
Calculate Caprini scores using multiple data sources: EMR, NSQIP data & Phone Survey
Study focuses on patients from Jan 2006 to May 2011
Calculate patient Caprini scores
Conducted phone survey
Results
Risk Level
Lowest Risk
Moderate Risk
Higher Risk
Highest Risk
Receiver Operation Characteristic Curve
Optimal specificity & sensitivity at score of
6
All Made Using STATA
Statistically Significant
Area under curve is 81%, therefore this is a good
test
Time Series
Many DVT/PE occurring after prophylaxis ended
It is necessary to continue post-op prophylaxis beyond what we currently do
Days Post-Op
Case #
LimitationsAffordability
Did not use “other risk factors”
Phone survey
Blood Work
Scores are too low
Score
≥% of Patients
6 24.49%
7 15.79 %
8 10.21 %
9 7.14 %
The next step…
Network with preadmissions and anesthesia to obtain the needed patient data and ensure accuracy
Discussion with anti-coagulation clinic
Revisit study & recalculate cutoff
Calculate “numbers needed to treat”
Examine potential cost savings from 30 day prophylaxis
Acknowledgements
Thanks again to Dr Joseph Caprini for his ongoing support
Special thanks to the SMH Director of Surgical Programs Lorraine Gillespie
Thank you to my co-authors Dr Peter Doris, Surgeon Champion, Chief of Surgery
at SMH Angela Tecson, SCR
Contact: [email protected]