Quantitative Analysis

Quantitative analysis: analyze care delivery to identify the rate-limiting steps 

Ultimately patients and providers care most about final clinical outcomes, like whether or not a patient has developed a hospital-acquired DVT or PE. Our chances to reduce the likelihood of hospital-acquired VTE begin the moment the patient is admitted (and actually recur every day!). To help your team focus its time on the most high yield interventions, it is extremely helpful to identify the most frequent sources of missed chances to prevent HA-VTE. If you are a perfectionist, these missed chances can be thought of as “rate-limiting steps.” If you are merely an optimist, they may be thought of as “high leverage points” for improvement.

Empirical analysis of each step below is very useful. We highly recommend the following brief exercise. Go to 20-30 random charts on your pilot unit. Tally up the prevalence of appropriate prophylaxis (as judged by your new gold standard, the VTE protocol). Next, look at the charts of the patients who were not on appropriate prophylaxis. If necessary, look also at the patient (i.e. to determine if mechanical prophylaxis is being worn). This should take no more than 2-3 hours, especially if you use a chart audit form. Once your chart audit is complete make a simple tally sheet of the type and number of failures; or alternatively you can annotate your diagram as below.

With quantitative information like this your improvement team can make rational choices when deciding which steps in care delivery to re-design and which steps to measure. For VTE prevention in the hospital above, a key moment occurs when physicians write admission orders. At this moment at least two different types of failure modes appear to contribute significantly to a poor overall baseline prevalence of VTE prophylaxis.

Download the VTE Implementation Guide Snapshot