Institutional Support

Ensure Support from Your Institution

Your time, energy, and expertise are necessary to drive improvement. But alone they will not be enough - absolutely essential is sponsorship and support from your medical center, specifically from key leaders. Such basics as revisions to order set, data collection or tweaks of your 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 you pause long enough to get a commitment from your institution to back your effort.

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

Make your 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 your project, including public reporting of hospital performance (e.g. The Joint Commission (TJC) 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 your administration.

In addition to using talking points in, you can use a bit of back-of-the-envelope math to get a gross estimate of impact. Over one year, a 300-bed hospital that lacks a systematic approach to VTE prevention can expect roughly 150 cases of hospital-acquired 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 a $20,000 price tag.

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 hospital-acquired VTE and the cases admitted to your medical center with pre-existing DVT or PE. At least half will be hospital-acquired (HA) VTE, and if your VTE prophylaxis rate is 50%, half of those will be preventable HA VTE. Alternatively, you can define that a patient has a 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. We will outline a more robust and accurate approach in the section on Performance Tracking, but in the meantime, these rough estimates can paint a picture to demonstrate the need to your peers and your administration.