A Guide for Effective Quality Improvement
Pulmonary embolism resulting from deep vein thrombosis—collectively referred to as venous thromboembolism—is the most common preventable cause of hospital death. Pharmacologic methods to prevent venous thromboembolism are safe, effective, cost-effective, and advocated by authoritative guidelines, yet large prospective studies continue to demonstrate that these preventive methods are significantly underused. Based on quality improvement initiatives undertaken at the University of California, San Diego Medical Center and Emory University Hospitals, this guide assists quality improvement practitioners in leading an effort to improve prevention of one of the most important problems facing hospitalized patients, hospital-acquired venous thromboembolism.
This project was funded under grant number Grant No. 1U18 HS015826-01 from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.
Select for print version (PDF File, 380 KB), Plugin Software Help.
Select for the presentation Venous Thromboembolism (VTE) Prevention in the Hospital (PowerPoint® File, 2.3 MB; Plugin Software Help).
Select for webinar presentation recording (Flash, 53 minutes, 20 seconds; Plugin Software Help). Select for transcript.
Prepared by: Society of Hospital Medicine; Greg Maynard M.D., M.Sc. University of California, San Diego Medical Center; and Jason Stein, M.D., Emory University Hospitals.
Copyright Information and Disclaimer
A Preventable Problem
How to Use This Guide
Chapter 1. Take Essential First Steps
Ensure Support From the Institution
Survey Previous or Ongoing Efforts and Resources
Clarify Key Stakeholders, Reporting Hierarchy, and Approval Process
Assemble an Effective Team
Set General Goals and a Timeline
Use a Structured Framework for Improvement to Plan and Guide Progress
Chapter 2. Lay Out the Evidence and Identify Best Practices
Know What the Literature Says
Construct the Venous Thromboembolism Protocol
Integrate the Venous Thromboembolism Protocol
Chapter 3. Analyze Care Delivery
Diagram Care Delivery to Identify Failure Modes
Analyze Care Delivery to Identify "Rate-Limiting Steps"
Chapter 4. Track Performance With Metrics
Key Metric 1: Prevalence of Appropriate Venous Thromboembolism Prophylaxis
Key Metric 2: Incidence of Hospital-Acquired Venous Thromboembolism
Data Reporting Using Run Charts
Transform General Goals Into a Metric-Specific Aim Statement
Chapter 5. Layer Interventions
The Venous Thromboembolism Protocol
Key Principles for Effective Quality Improvement Interventions
Beyond the Venous Thromboembolism Protocol: Using a "Hierarchy of Reliability"
Chapter 6. Continue to Improve
Learning in the Clinical Setting: Plan-Do-Study-Act
Spreading Improvement to Other Units
Appendix A. Talking Points to Attract Administration Support for Venous Thromboembolism Prevention Programs
Appendix B. Sample Venous Thromboembolism Protocol/Order Set
Appendix C. Suggested Reading for Venous Thromboembolism Protocol Development
Appendix D. Chart Audit Form 44
For manuscript review, we also are deeply indebted to Kathleen Kerr, Tina Budnitz, and the members of the Hospital Quality and Patient Safety Committee of the Society of Hospital Medicine.
Disclaimer and Copyright Information
No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.
This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated.
This guide (AHRQ Publication Number 08-0075) can be ordered through the Publications Clearinghouse by calling 800-358-9295. From outside the United States, call 703-437-2078. Toll-free TDD services for the hearing impaired are available by calling 888-586-6340. E-mail requests for AHRQ Publication Number 08-0075 may be made to AHRQpubs@ahrq.hhs.gov. Mailed requests can be sent to AHRQ Publications Clearinghouse, Re: AHRQ Publication No. 08-0075, P.O. Box 8547, Silver Spring, MD 20907.
Current as of August 2008
Maynard G, Stein J. Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. AHRQ Publication No. 08-0075, August 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/vtguide/