Research in hospital care delivery has yet to elucidate a transferable strategy to deliver optimal care on a consistent basis. Most hospitals struggle even to generate the regular data flow necessary to track performance. We hypothesized that both these problems could be solved simultaneously through a daily harvest of electronic data that identified quality outliers and relayed them to the nursing unit. We used a key hospital quality process measure — prophylaxis against venous thromboembolism (VTE) — to test this “situational awareness” hypothesis.
Using a time series design, a solitary intervention was introduced in staggered fashion on 3 nursing units in 2 hospitals. The intervention consisted of a daily relay to the nursing unit of a list of patients without orders for VTE prophylaxis. Unit nurses were encouraged to use the situational awareness created by the list of outliers to confirm whether the lack of an order was intentional. Although the medical and nursing staffs were unique to each site, both hospitals shared the same electronic medical record and the same standardized, paper‐based decision support for determining VTE risk, contraindications to pharmacological prophylaxis, and evidence‐based options for appropriate prophylaxis. The data harvested to generate the prophylaxis outlier list was used to chart the daily prevalence of VTE prophylaxis.
On 2 of the 3 nursing units, the intervention achieved an immediate and substantial effect (Fig. 1). The mean prevalence of prophylaxis increased from 73% to 99% (P < .01) and from 62% to 98% (P < .01) in the first nursing units in hospitals A and B, respectively. On the second nursing unit in hospital A, the effect was delayed and smaller, with the mean prevalence of prophylaxis increasing from 68% to 87% (P < .01).
Figure 1. Statistical process control chart depicting the effect of situational awareness on prevalence of VTE prophylaxis on 3 nursing units in 2 hospitals.
The results strongly suggest that situational awareness created by daily relay of VTE prophylaxis outliers to nursing units can dramatically increase the prevalence of prophylaxis in settings with standardized, paper‐based decision support. Our results also suggest that this strategy is transferable within and across hospitals and can function as a de facto performance‐tracking system. Similar interventions that make use of situational awareness on the nursing unit may be applicable to other quality measures.
J. Stein, MD, Emory University School of Medicine, Independent Contractor, SHM, Shareholder, Ingenious Med Inc.; S. Tejedor, MD, none; H. Shabbir, MD, none.
To cite this abstract:Stein J, Tejedor S, Shabbir H, O'Malley E. Situational Awareness Improves Prevalence of VTE Prophylaxis on Multiple Nursing Units. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 74. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/situational-awareness-improves-prevalence-of-vte-prophylaxis-on-multiple-nursing-units/. Accessed September 16, 2019.