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Table 5. Armamentarium of Quality Improvement Strategies

Preventing Hospital-Acquired Venous Thromboembolism

Quality Improvement Strategy CategorySpecific Ideas for VTE Prevention
Provider education
  • 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.
Patient education
  • 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

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).

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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Current as of August 2008
Internet Citation: Table 5. Armamentarium of Quality Improvement Strategies: Preventing Hospital-Acquired Venous Thromboembolism. August 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/vtguide/vtguidetab5.html