Blog | Monday, May 27, 2019

Hospital first in nation to offer DVT prophylaxis to doctors

Hope Bulon Hospital, a large community hospital in the Midwest, made history last week when it became the first in the country to offer DVT (deep vein thrombosis) prophylaxis to all its doctors. A DVT is a potentially dangerous blood clot that forms in the legs, and is associated with long periods of immobility. Standing outside the hospital next to a group of delighted doctors, CEO Michael Kidhead announced that his hospital had started the initiative after a series studies were released since the beginning of the year. “The medical studies are indisputable evidence of the risks that doctors have been placed at over the last several years. We wanted to be seen as pro-active in the field of DVT risk reduction for our physicians.” Dr. John Boyo, the chief of medicine at the hospital, and a general internist, later added: “Our doctors couldn't be happier, and there's been an almost 100 percent take-up rate so far.”

So what's behind this move? New research suggests that since the widespread roll-out of electronic medical records across the country over the last 10 years, physicians are spending the vast majority of their long days, over 80 percent, sitting at computer terminals performing documentation and data entry tasks. “The risks are very real,” says Dr. Robert Muds, author of one the studies. “We have found that for every extra hour doctors spend sitting down, their risk of developing DVTs goes up significantly.”

Hope Bulon hospital started sending a dedicated nurse around the hospital every 8 hours to administer the heparin injections (a medication that helps thin the blood). “We found that some of our doctors would round with patients for an hour in the morning, and then sit it at their computer for the next 10 hours. Because of the volume of documentation that was required by doctors, and the urgency of entering the information, they would often not move for the entire day. It was necessary for the nurse to go around and administer the injection, rather than require any physician move to a treatment area.”

This move looks set to be repeated at numerous other institutions. Two nearby tertiary care centers are set to roll out similar initiatives within the next month, and other hospital leaders all over the United States, are voicing their support. Hope Bulon's CEO Kidhead added, “Our administrators are keen to help in any way possible. While physicians are at their computer terminal, we make sure a constantly available phone line and any other support is available. They can easily answer pages from nurses and speak to patients and families in their rooms during the day. This negates them leaving their chair and having face-to-face conversations, which could be on the other side of the hospital, and leave them unable to perform any data entry for those long periods of time. However, we want this to be safe for the doctor, their health is important to us. Physician well-being is a priority at our institution.”

However, there are some who argue that the move doesn't go far enough. Dr. Raj Daba, author of another large soon-to-be published study, states that their preliminary results show that smaller doses of heparin are not enough. “Some of the physicians we followed were very high-risk indeed, and we wanted to take a more aggressive approach, and attach them to a heparin drip for the whole day. This almost completely negated the risk of blood clots forming in the legs, and then spreading to the lungs causing a pulmonary embolus.” Daba's team also has additional smaller studies underway, looking at other orthopedic and ophthalmological cutting-edge prophylactic treatments that may benefit physicians while they are on the computer. But for now, he is happy to maintain his focus on the blood clot risk.

If the take-up rates from Hope Bulon Hospital are anything to go by, physicians appear to be keen to lower their own individual risks, by whatever means necessary. “We have seen the emerging research and know the amount of immobile time we are spending throughout the day. I am proud to be part of a hospital system that takes physician well-being seriously like this”, said Dr. Carol Joobs, a newly graduated internal medicine physician at the hospital. “My father was a solo-practice physician and used to clock miles every day running around the hospital, back and forth from his office seeing patients. But these are new times in medicine. I see heparin injections as only the beginning. The newer oral anticoagulants will ultimately be the most convenient and cost-effective tool. We're just waiting for the research to come out.”

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.