Illinois Surgical Quality Improvement Collaborative
Working Together to Achieve Rapid and Sustained Improvement for Surgical Patients
Comprehensive Venous Thromboembolism (VTE) Prophylaxis
The current, publicly reported venous thromboembolism (VTE) outcome measure (PSI-12) has significant flaws due to surveillance bias, and the VTE process measure (SCIP-VTE-2) only measures the provision of prophylaxis in the 24 hours before and after surgery.
The Problem
The ISQIC Solution
ISQIC Postoperative VTE Prophylaxis Toolkit
Are you interested in learning more about the VTE Prophylaxis Composite Process Measure Toolkit or our work related to patient refusals? Contact us at info@isqic.org for more information.
VTE Prophylaxis Composite Process Measure
ISQIC has developed and implemented a composite process measure of postoperative VTE prophylaxis that improves on the limitations of prior measures and is particularly useful to hospitals in identifying specific targets for improvement. The three components of the composite VTE prophylaxis process measure are the three widely accepted components of optimal postoperative VTE prophylaxis: 1) early ambulation (ordered and attempted at least once within the first 24 hours after surgery), 2) sequential compression devices (ordered, on the patient, and working at least once within in the first 24 hours after surgery), and 3) chemoprophylaxis (ordered at the correct dose and frequency throughout each patient’s entire hospitalization). For each component measure, there are reasonable clinical exceptions that would allow a patient to pass the measure even if one of the components was not completed. A patient only passes the composite measure if all three component measures are passed. Importantly, the measure can be adapted to focus on one component such as chemoprophylaxis, ensuring correct dose, timing, and delivery of all doses throughout the hospital stay.
The composite VTE prophylaxis process measure can help hospitals identify their local, specific failures in VTE prophylaxis (e.g., ordering, administration, patient refusal, etc.), and also reliably benchmark and compare performance between hospitals.
ISQIC Postoperative VTE Prophylaxis Toolkit
Once hospitals have identified their specific failures with postoperative VTE prophylaxis, they can then implement interventions targeted toward the specific failures they have identified using a “VTE Toolkit” provided by the ISQIC Coordinating Center. The VTE Toolkit contains rigorously identified interventions with known efficacy in improving VTE prophylaxis. The Toolkit groups interventions by the failure mode addressed by each intervention and includes a guide to assist hospitals in choosing the intervention(s) that are most likely to be effective in addressing their local failures of VTE prophylaxis. In this way, they will be able to quickly and efficiently move from data analysis and identification of problems into interventions that will significantly improve the quality of care provided at their hospital.
Decreasing Patient Refusal of VTE Prophylaxis
In addition to the materials included in the toolkit, ISQIC has also developed additional materials specifically focused on reducing patient refusals to VTE prophylaxis including a patient handout, materials to increase patients’ role in their own care, templates to provide feedback reports to nurses on their refusal rates, and more.
For more information, contact Lindsey Kreutzer at 312-503-3856 or lkreutzer@isqic.org