Institute for Healthcare Improvement: Expedition: Preventing Venous Thromboembolism in Hospitalized Patients: Risk Assessment

OVERVIEW

This program is one way that IHI is helping hospitals implement a key component of the IHI Improvement Map.

The Climb
Venous thromboembolism (VTE) covers a spectrum of clinical problems, including asymptomatic calf vein thrombosis, symptomatic deep vein thrombosis (DVT), and pulmonary embolism (PE). These diagnoses are significant causes of mortality and morbidity with admissions to the hospital associated with both DVT and PE.

Hospitalized patients are at greater risk of VTE due to surgery, prolonged immobilization, use of certain medications, and presence of other conditions such as obesity, congestive heart failure, and cancer. VTE is a leading cause of preventable death in hospitalized patients, with as many as 10% of deaths estimated from PE. Additionally, the treatment of non-fatal symptomatic VTE and long-term associated morbidities are connected to considerable health care costs. Assessing risk and initiating prophylaxis, which is now a routine part of hospital care in the UK, have the potential to save lives, reduce harm, and reduce the cost of care.

The National Quality Forum has identified DVT/VTE as a significant patient safety issue resulting in the endorsement that each patient be evaluated upon admission, and regularly thereafter, for the risk of developing DVT/VTE. Further, as of July 31, 2008, the Centers for Medicare & Medicaid Services (CMS) put into effect a rule which states that, if a patient who has a total knee or hip replacement develops DVT or PE while hospitalized, the hospital will be paid as if the complication were not present.

The Goal
The aim of this Expedition is to enable participants to assess all hospitalized patients for VTE risk on admission in order to start needed prophylaxis.

At the conclusion of this Expedition, participants will be able to:

Identify the common risk factors for VTE in hospitalized patients
Describe processes used in other organizations to assess patients on admission for VTE risk
Implement a reliable process for assessment of VTE risk in hospitalized patients

Who Should Attend

Doctors
Nurses
Directors
Managers
Quality personnel

WHAT IS AN EXPEDITION?

WHAT'S INVOLVED?

ex•pe•di•tion (noun)

1. an excursion, journey, or voyage made for some specific purpose

2. the group of persons engaged in such an activity

3. promptness or speed in accomplishing something

An Expedition is a topic-specific, action-focused program, lasting three to five months, designed to help front-line teams make rapid improvements in a key components of the Improvement Map. Think of it as an intensive virtual support system, designed to enable widespread uptake of an important hospital improvement.

This Expedition is for hospitals that would like some help along the way from expert faculty serving as your guides and through the support of other organizations who are taking on the same challenge at the same time.

Successful Expedition

“The CA-UTI Expedition . . . was a wonderful experience. Participating in an IHI-sponsored national project helped our credibility and increased our ability to overcome challenges that might have been insurmountable a few months ago. We have made progress by taking part in the Expedition and we will continue to build on what we have learned thus far. We would definitely recommend that any hospital participate in an Expedition if they are interested in making changes . . . that lead to better patient outcomes.”

Pam Webb, RN, CIC
InfectionControl Officer
Benefis Hospital
Great Falls, MT

The Program

This program will include:

Send-Off Call to orient all teams, review the route, and provide guidance for specific steps
Check-In Calls every two weeks for faculty to provide advice and mid-course adjustments
Ongoing opportunities to share with and learn from other participating organizations
Opportunities for periodic check-ins with faculty
Concluding Call to reflect on the achievement and plot the next climb

Success Factors

Teams will need the following to be successful in this Expedition:

Strong team-based improvement capacity
Designated team, ideally to include a nurse working on the testing unit or able to lead the work, an internal quality/performance improvement expert, and a physician champion
Sponsorship and support from hospital leadership
Clear commitment to the goal and the process