Institutional Support

Ensure Support from the Institution

The time, energy, and expertise of a physician leader are necessary to drive improvement. But alone they will not be enough - absolutely essential is sponsorship and support from the medical center, specifically from key leaders. Such basics as revisions to order sets, data collection resources, or tweaks of health information system may require special permission, fast-track approval processes, or dedicated personnel. While most obstacles will require merely patience or ingenuity, some may be insurmountable without the influence of executive leadership.

Real support should confer the authority and resources needed for the improvement team to design and manage change. We strongly recommend that the quality improvement practitioner pauses long enough to get a commitment from the institution to back the effort.

The single most effective way to attract this support is by aligning the goals of the QI effort with the strategic goals of the organization. 

Make hospital leadership aware of how an effective VTE prevention program aligns with its goals for medical care, performance reporting, customer service, and cost containment. A number of forces may fuel administrative interest in the project, including public reporting of hospital performance (e.g. The Joint Commission and National Quality Forum measures), cost savings from more efficient care, risk aversion, favorable payments for better care (e.g. Pay-for-Performance), nursing and medical staff retention (e.g. Magnet Recognition Program), related projects (Surgical Care Improvement Project), and even quality for quality’s sake. View “Talking Points” to garner support from administration.

In addition to using the talking points , simple calculations, or “back-of-the-envelope math” are useful for gross estimates of impact. Over one year, a 300-bed hospital that lacks a systematic approach to VTE prevention can expect roughly 150 cases of HA-VTE. Approximately 50-75 of those cases will be potentially preventable through missed opportunities to provide appropriate prophylaxis. Approximately 5 of those patients will die from potentially preventable PE. Each hospital-acquired DVT represents an incremental inpatient cost of $10,000, while each PE represents approximately $20,000 in additional cost.

Another quick method to estimate the impact of a VTE prevention program uses coding information as follows: run a query using all codes for DVT and PE. These codes will represent both the HA-VTE and the cases admitted to the medical center with pre-existing DVT or PE.  At least half will be HA-VTE, and if the VTE prophylaxis rate is 50%, half of those will be potentially preventable HA-VTE. Alternatively, patient may be defined as having HA-VTE when the diagnosis code is a secondary (rather than primary) diagnosis.

Both above methods can only generate a rough estimate of the impact of a VTE prevention program. A more robust and accurate approach is outlined in the section on Track Performance. But these rough estimates can paint a useful picture to demonstrate the need to members of care teams and to administration.