REDUCING HOSPITAL-ASSOCIATED VTE IN 35 HOSPITALS: A COLLABORATIVE QUALITY IMPROVEMENT PROJECT

Ian Jenkins, MD, SFHM*1;Tamra O'Bryan, MHA RHIA CPHQ2;Janet Holdych, Pharm D, CPHQ2 and Dr. Gregory Maynard, MD MS MHM3, (1)University of California San Diego Health System, San Diego, CA, (2)Dignity Health, Redding, CA, (3)UC Davis Health System, Sacramento, CA

Meeting: Hospital Medicine 2017

Categories: Plenary Presentations, Research Abstracts

Keywords: , ,

Background:

Hospital-associated venous thromboembolism (HA-VTE) is a serious condition with controversy regarding ideal risk assessment and VTE prophylaxis (VTEP), especially in medical patients. We conducted a collaborative VTE quality improvement project, supported by a charitable grant from the Gordon and Betty Moore Foundation, in 35 hospitals across three states and assessed the impact on HA-VTE rates.

Methods:

Data management, order set design, and hosted webinar support were provided centrally. All hospitals formed multi-disciplinary teams to drive local educational efforts and address lapses in VTEP. Interventions included:

  • A standardized, 3-bucket risk assessment module linked to a protocol of pharmacologic and mechanical VTEP, embedded in order sets
  • 9 “pilot” sites received mentored implementation modeled after SHM collaboratives; 26 “spread” sites did not
  • Measure-vention (measurement and real-time correction of defects) was funded in pilot sites and encouraged in spread sites

HA-VTE events (during hospitalization or present on admission within 30 days of prior discharge) were collected from coding data. 2011 was considered the baseline year, 2012-13 intervention years, and 2014 the mature period for comparison. Data collection for VTEP did not begin until 2012-2013. All sites monitored compliance with TJC VTE measures 1&2 (“any” VTEP). Measure-vention sites also determined whether VTEP was adequate according to the protocol. 

Results:

5370 HA-VTE occurred during 1.16 million admissions during the study period. TJC VTE-1 and 2 performance and protocol appropriate VTEP rates both reached 97% in 2014, up from 2012-13 performance of 78-87%. Across all 35 sites, 428 fewer HA-VTE occurred in 2014 than in 2011 (RR 0.78, 95% CI [0.73 – 0.85]). Pilot sites enjoyed a more robust reduction in HA-VTE than Spread sites (26% vs 20%). Heparin induced thrombocytopenia and adverse effects from anticoagulants were reduced or unchanged (Table). The average annual HA-VTE rate over the study was higher in surgical patients [5.7 (pilot) and 7.3 (spread)/1000] than medical patients (3.3 and 3.6 /1000). In medical patients, most HA-VTE occurred post-discharge (2740 of 3416; 80%); in surgical patients, most occurred during the index admission (1611 of 2630, 61%)(Figure).

Conclusions:

Our collaborative QI project was associated with a reduction in HA-VTE across a broad medical-surgical inpatient population. Interventions proved easy to disseminate across multiple hospitals. HA-VTE rates can be improved, even when already low (~0.5%).

To cite this abstract:

Jenkins, I; O'Bryan, T; Holdych, J; Maynard, G . REDUCING HOSPITAL-ASSOCIATED VTE IN 35 HOSPITALS: A COLLABORATIVE QUALITY IMPROVEMENT PROJECT [abstract]. Journal of Hospital Medicine. 2017; 12 (suppl 2). http://www.shmabstracts.com/abstract/reducing-hospital-associated-vte-in-35-hospitals-a-collaborative-quality-improvement-project/. Accessed December 15, 2017.

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