Preventing acute care–associated venous thromboembolism in adult and pediatric patients across a large healthcare system

Abstract

BACKGROUND Although effective methods for venous thromboembolism prophylaxis (VTE‐P) have been known for decades, reliable implementation has been challenging. OBJECTIVE Develop reliable VTE‐P systems for adult and for pediatric patients to reduce preventable venous thromboembolism (VTE). DESIGN We used a discovery and diffusion system to first develop an effective system in 1 hospital location, and then spread the principle best practices across the entire 22‐hospital system. SETTING Twenty‐two Mayo Clinic hospitals (adults and children). PATIENTS Adult and pediatric patients. INTERVENTION (1) Ensure that a VTE‐P is declared at admission by providing a mandatory VTE‐P “tollgate” that requires the provider to assess the risk for VTE and provide an appropriate order for VTE‐P. (2) Use clinical decision support to provide ongoing surveillance and alerts to providers when there is a lapse in the VTE‐P plan. MEASUREMENTS In adults, VTE compliance as measured by the Centers for Medicare and Medicaid Services Core Measures VTE‐1 and VTE‐2, preventable VTE as measured by VTE‐6, and in pediatric patients, appropriate VTE measures as determined by chart audit. RESULTS VTE‐1 and VTE‐2 have approached 97% to 100% and preventable VTE has declined to 0% for the last 3 quarters. Similarly, the pediatric VTE‐P screening tool was evaluated and piloted with >92% compliance in risk documentation, appropriate VTE‐P >64%, and 0 VTE events during the study period. CONCLUSION An integrated system‐wide approach can lead to measurable improvements in VTE‐P process and outcome measures. Journal of Hospital Medicine 2016;11:S15–S21. © 2016 Society of Hospital Medicine

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