Illinois Surgical Quality Improvement Collaborative
Working Together to Achieve Rapid and Sustained Improvement for Surgical Patients
Post-Discharge VTE Prophylaxis
The Problem
According to the CDC, VTE is the leading cause of preventable hospital death in the United States. Each year, approximately 900,000 people in the U.S. are affected by blood clots (DVT/PE), of which approximately 50% are healthcare-associated (CDC Venous Thromboembolism, 2017). Surgery is a major risk factor for VTE, especially lower limb orthopedic procedures (total knee and hip arthroplasty specifically) and abdominal/pelvic surgery for cancer.
The ISQIC Solution
Post-Discharge Extended VTE Chemoprophylaxis Best Practice Adherence Measure
ISQIC has developed and implemented a best practice adherence (process) measure for post-discharge extended VTE chemoprophylaxis that is particularly useful to hospitals in identifying specific targets for improvement. The major components of the measure include indication, ordering of VTE chemoprophylaxis at the time of discharge, type of chemoprophylaxis ordered, and prescription duration (days). There are reasonable clinical exceptions that allow a patient to pass the measure even if post-discharge VTE chemoprophylaxis was not ordered. A patient only passes the measure if the appropriate type and prescription duration (number of days) of VTE chemoprophylaxis was prescribed at the time of discharge or if a reasonable clinical exception applies.
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The post-discharge extended VTE chemoprophylaxis measure can help hospitals identify their local, specific failures in regards to appropriately prescribing post-discharge VTE chemoprophylaxis (e.g. type, duration, acceptable exceptions) and also reliably benchmark and compare performance between hospitals.
Post-Discharge Extended VTE Chemoprophylaxis Toolkit
Once hospitals have identified their specific failures with prescribing post-discharge extended VTE chemoprophylaxis, the “Post-Discharge VTE Chemoprophylaxis Toolkit” can be utilized by hospitals to identify and implement targeted interventions. The Toolkit, provided by the ISQIC Coordinating Center, contains information from peer-reviewed articles and other credible sources such as Centers for Disease Control and Prevention, American Heart Association and US Department of Health and Human Services, American College of Chest Physicians, etc. The Toolkit is comprised of numerous topics such as an overview of venous thromboembolism, risk assessment tools, published evidence, patient education, patient payment programs, discharge planning lists, provider education, clinical decision support, and stakeholder buy-in strategies.
For more information, contact Briana D'Orazio at bdorazio@isqic.org