Thank you for your suggestion.   The intent of the measure is for all hospitalized patients to be evaluated for VTE prophylaxis and to receive appropriate prophylaxis when indicated in a timely manner.   The numerator defines this timeframe as the day of or day after admission. The timeframe for prophylaxis is potentially extended by one day when surgery is performed the day of or the day after admission, as the numerator allows for prophylaxis the day of or day after surgery. Days are measured in calendar days, not hours.   However, the measure does exclude cases with a length of stay of <2 days.   Therefore, whether or not the scenario you provide should or should not be included in the numerator depends on the timing between the admission and the discharge. If the surgery occurs on the day of admission, the case should be excluded. If surgery occurs the day after admission, the patient should receive prophylaxis or a documented reason for not receiving prophylaxis.   Example 1: Pt Admitted 3/1, Surgery 3/2, Discharge 3/3, no prophy given   *To qualify for exclusion, LOS would have to be < 2 days. LOS Day 0 = (3/1) Admit Day LOS Day 1= (3/2) Surgery Day LOS Day 2= (3/3) Discharge Day RESULT = LOS equals 2 days, case is not excluded.   *Numerator requires prophylaxis or reason for no prophylaxis <= 1 days after the end of anesthesia PROPHY Day 0 = (3/2) Surgery Day PROPHY Day 1 = (3/3) Discharge Day   RESULT = Patients who do not receive prophylaxis fail the numerator.   Example 2: Admitted 3/1, Surgery 3/1, Discharge 3/2, no prophy given LOS Day 0 = (3/1) Admit Day LOS Day 1= (3/2) Discharge Day   RESULT = LOS <2 days, case is excluded. Numerator is not evaluated.   Example 3: Admitted 3/1, Surgery 3/3, Discharge 3/4, no prophy given   LOS Day 0 = (3/1) Admit Day  LOS Day 1 = (3/2)  LOS Day 2 = (3/3) Surgery Day  LOS Day 3 = (3/4) Discharge Day   RESULT = Patient did not undergo surgery the day of or the day after admission. Patients who do not receive prophylaxis on Day 0 or Day 1 in this scenario fail the numerator.

The following scenario is currently not supported within the VTE-108 algorithm and we request its consideration for the next version of this measure: Inpatient undergoes surgical procedure after admission and is discharged the following day which is prior to the deadline for “VTE applied”. Timeframe between anesthesia end and discharge is less than 2 days. Please consider allowing this patient path to be an exclusion in the next version of VTE-108.