News in brief: One in ten hospital-acquired VTE preventable; IVIG use increases in Kawasaki disease; New MBS item for allied health case conferencing

Thursday, 4 Nov 2021

One in ten hospital-acquired VTE preventable

Most hospital-acquired VTE are not preventable even when patients have received optimal care, a study conducted at two Sydney hospitals has found.

A retrospective review of 135 patients determined to have actual hospital-acquired VTEs found that only one in ten were potentially preventable.

Most of the patients (65%) had one or more contraindications to receive recommended prophylaxis and in the remainder, the VTE occurred in patients who were at either medium or high risk and mostly receiving optimal prophylaxis, the study found.

The proportion of VTE patients who received suboptimal prophylaxis was 11% , mostly due to missed or delayed doses or suboptimal doses.

Writing in the Internal Medicine Journal, the researchers said the findings suggested that hospitals should focus on measuring and reporting VTE that are preventable to provide a more accurate measure of the burden of VTEs that can be reduced by improving care.

IVIG use increases in Kawasaki disease

A ‘clear increasing trend’ in use of Intravenous immunoglobulin for children with Kawasaki disease has been seen over the last 25 years.

According to national datasets of all IVIG treatment provided for Kawasaki disease between 2007 and 2016 and hospitalisations for Kawasaki disease from 1993-2018, the increase is primarily in 1-4 years olds.

The study, published in the Journal of Paediatrics and Child Health, said the IVIG-treatment rate was 14.31 per 100,000 person-years in the 0-4 year age group and the hospitalisation rate was 14.99 per 100,000 person-years during the overlapping nine year period 2007-2016.

The concordant results from two independent datasets increased confidence in the estimate of the high incidence rate.

“This is markedly higher than the previous estimate of Australian incidence of 9.34 per 100,000 person-years, suggesting that the incidence of KD in Australia is approaching that reported in the USA (20.8 per 100,000 per annum), and Canada (20.5 per 100,000 per annum), and is considerably higher than that reported most recently in the UK (8.39 per 100,000 per annum).”

The investigators, led by Dr Ryan Lucas from the Sydney Children’s Hospitals Network, also noted a peak in the IVIG treatment rate in September nationally.

“High-quality, standardised prospective surveillance is warranted to understand the evolving epidemiology of KD in Australia and elsewhere to inform clinical and scientific priorities,” they concluded.

MBS item for allied health case conferencing

New Medicare items will allow allied health professionals to be reimbursed for taking part in case conferences to support people with chronic diseases or young children with developmental disorders.

From 1 November allied health professionals will be paid to attend multidisciplinary conferences held by the patient’s regular doctor – in person, via video conference or phone –to discuss diagnosis, care and treatment plans.

The new items are for eligible allied health professionals participating in multidisciplinary case conferences for people with chronic disease under the care of a General Practitioner as part of Team Care Arrangements, as well as children aged under 13 years under the care of a specialist, consultant physician or GP to provide early diagnosis and treatment of autism or any other pervasive developmental disorders.

For chronic disease management, eligible professionals include: Aboriginal and Torres Strait Islander health practitioners and health workers, audiologists, chiropractors, diabetes educators, dietitians, exercise physiologists, mental health workers, occupational therapists, osteopaths, physiotherapists, podiatrists, psychologists and speech pathologists.

For children with pervasive developmental disorders: Aboriginal and Torres Strait Islander health practitioners and health workers, audiologists, mental health nurses, mental health workers, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists and speech pathologists can take part.

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