Table 5. Armamentarium of Quality Improvement Strategies
|Quality Improvement Strategy Category
||Specific Ideas for VTE Prevention
- Didactic sessions on VTE prevention (e.g., noon conference or grand rounds).
- Distributed educational materials (e.g., pocket cards with VTE risk factors).
|Provider reminder systems
- Prompts nested within paper admission, transfer, or post-op order sets supported by VTE risk assessment as decision support (VTE protocol).
- Prompts using computerized physician order entry with risk assessment as decision support (VTE protocol).
- Stickers on charts or posters in order-writing areas.
|Facilitated relay of clinical data to providers
- Alerts to physicians by means other than medical records (e.g., page, electronic alert, phone call, or e-mail regarding VTE prophylaxis oversights).
|Audit and feedback of performance to providers
- Feedback of VTE prophylaxis performance to individual providers or groups of providers with or without benchmarking to top performer.
- Discrete disclosure to patients of increased risk for VTE (e.g., pamphlets, physician or nurse teaching of patient or caregiver, closed-circuit television program in patient rooms).
|Organizational or operational change
- Administrative support personnel dedicated to ensure constant stocking of VTE protocol order set in needed areas.
- Clinical support personnel dedicated to ensure and document that mechanical prophylaxis is worn by patients.
- Hospital-wide or unit-specific teams or individuals with regular responsibility to ensure each patient is receiving appropriate VTE prophylaxis (e.g., physician, nurse, pharmacist).
|Incentives, regulation, and policy
- Recognition of highest performers each month or quarter.
- Financial incentives based on achievement of VTE prophylaxis performance goals.
- Punitive actions for failures to meet minimum performance (e.g., suspension of privileges).
Health system directed:
- Enforced policy mandating use of VTE protocol (e.g., "hard stops" in processing of admission, transfer, or post-operative orders that fail to prescribe VTE prophylaxis).
Source: Adapted from Stein J. The Language of Quality Improvement: Therapy Classes. J Hosp Med. 2006 Nov;1(6):327-30.
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