Table 5. Armamentarium of Quality Improvement Strategies

• Didactic sessions on VTE prevention (e.g., noon conference or grand rounds).
• Distributed educational materials (e.g., pocket cards with VTE risk factors).

• 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.

• Alerts to physicians by means other than medical records (e.g., page, electronic alert, phone call, or e-mail regarding VTE prophylaxis oversights).

• 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).

• 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).

Provider directed:

• 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).