Preventing acute care–associated venous thromboembolism in adult and pediatric patients across a large healthcare system

BACKGROUND: Although effective methods for venous thromboembolism prophylaxis (VTE-P) have been known for decades, reliable implementation has been challenging. OBJECTIVE: Develop reliable VTE-P systems for adult and for pediatric patients to reduce preventable venous thromboembolism (VTE). DESIGN: We used a discovery and diffusion system to first develop an effective system in 1 hospital location, and then spread the principle best practices across the entire 22-hospital system. SETTING: Twenty-two Mayo Clinic hospitals (adults and children). PATIENTS: Adult and pediatric patients. INTERVENTION: (1) Ensure that a VTE-P is declared at admission by providing a mandatory VTE-P “tollgate” that requires the provider to assess the risk for VTE and provide an appropriate order for VTE-P. (2) Use clinical decision support to provide ongoing surveillance and alerts to providers when there is a lapse in the VTE-P plan. MEASUREMENTS: In adults, VTE compliance as measured by the Centers for Medicare and Medicaid Services Core Measures VTE-1 and VTE-2, preventable VTE as measured by VTE-6, and in pediatric patients, appropriate VTE measures as determined by chart audit. RESULTS: VTE-1 and VTE-2 have approached 97% to 100% and preventable VTE has declined to 0% for the last 3 quarters. Similarly, the pediatric VTE-P screening tool was evaluated and piloted with >92% compliance in risk documentation, appropriate VTE-P >64%, and 0 VTE events during the study period. CONCLUSION: An integrated system-wide approach can lead to measurable improvements in VTE-P process and outcome measures. Journal of Hospital Medicine 2016;11:S15–S21.