Overview | Venous Thromboembolism (VTE) Implementation Toolkit

Download the VTE Implementation Guide

This implementation toolkit is built on well-proven principles of quality improvement, evidence-based medicine as well as personal and institutional experiences. An in depth look at previous or ongoing efforts and resources followed by a redesign in process, work flow, and information transfer and sharing is needed in order to implement an effective team-based approach to prevent hospital-acquired venous thromboembolism (VTE).

Apply to the VTE PC Mentored Implementation Program which leads institutions through the process of implementing the principles outlined in this implementation toolkit. The goal of this implementation toolkit is to enhance the efficiency and reliability of your quality improvement efforts to close the gap between best practice and what we actually do to prevent one of the most common causes of hospital deaths, hospital-acquired venous thromboembolism (VTE). In order to implement effective protocols and other QI strategies to minimize hospital-VTE in your institution redesign is needed in care delivery and performance tracking.

This implementation toolkit will enable you to implement effective protocols by providing you with information on:

VTE | Overview

How to Use:

The Venous Thromboembolism (VTE) Implementation Toolkit is the online version of the Venous Thromboembolism Implementation Guide and addresses in detail the essential elements for reaching breakthrough levels of improvement in the care. Review the How to Use portion of the toolkit for guidance and an introduction to the information you will find in the implementation toolkit whether you are just beginning a quality improvement (QI) initiative or have been part of on-going improvement efforts.

Implementation Guide:

Download and print the VTE Implementation Guide entitled, Preventing Hospital-Acquired Venous Thromboembolism, A Guide for Effective Quality Improvement, Version 3.3, which serves as the portable version of the Venous Thromboembolism Implementation Toolkit.

First Steps:

Set up your team for success. Move ahead only with the support of your institution and an understanding of your environment. Know where you are going and how you will get there by setting goals and using a framework for improvement.

  1. Ensure support from the institution.
  2. Survey previous or ongoing efforts and resources.
  3. Clarify key stakeholders, reporting hierarchy, and approval process.
  4. Assemble an effective team.
  5. Set general goals and a timeline.
  6. Follow a framework for improvement.

Best Practices:

Review what the literature says about inpatient glycemic control. Package that knowledge into a protocol that is aligned with the scope of your project.

  1. Know what the literature says about patients’ risk for VTE.
  2. Know what the literature says about options for preventing VTE.
  3. Draft your VTE Protocol

Analyze Care Delivery:

Diagram your current care delivery. Understand its inter-related steps and failure modes. View care delivery as a series of intermediate steps leading to the clinical endpoint of interest. Recognize which steps should become metrics for VTE prevention.

  1. Qualitative analysis: diagram care delivery to identify failure modes.
  2. Quantitative analysis: analyze care delivery to identify rate-limiting steps.

Track Performance:

Select key metrics. Collect the data needed to track performance on these metrics. Plot and report data on a run chart. Write the aim statement that will be your benchmark for success. Consider tracking balancing measures.

  1. Key metric #1: Prevalence of appropriate VTE prophylaxis.
  2. Key metric #2: Incidence of Hospital-acquired VTE.
  3. Data collection.
  4. Data reporting using run charts.
  5. Transform general goals into a metric-specific aim statement.

Reliable Interventions:

Start with an effective VTE Protocol. Really integrate it. Then, raise performance incrementally by moving up a hierarchy of increasing reliability.

  1. The VTE protocol
  2. Key principles for effective interventions (including the VTE Protocol).
  3. Beyond the VTE protocol: layering complimentary interventions.

Continue to Improve:

Learn by testing and refining change in the clinical setting. Revise the VTE Protocol to embrace appropriate variation. Take steps to weed out inappropriate variation. Spread your improvements to other units.

  1. Learning in the clinical setting: Plan-Do-Study-Act.
  2. Spreading improvement to other units.

You will also have access to:

Why Should You Act? Click to expand

  • PE resulting from DVT is the most common cause of preventable hospital death. 1
  • A U.S. multicenter registry study showed the majority of hospitalized patients with risk factors for DVT did not receive prophylaxis. 2
  • The rate of fatal PE more than doubles between the ages 50 and 80 years. 3
1 Bosker G, Poponick J, Emerman CL, Kleinschmidt K. The current challenge of venous thromboembolism (VTE) in the hospitalized patient. Part II: Treatment and prevention of DVT and PE - evolving risk-stratification and prophylaxis strategies for hospital-based medicine.
Accessed October 28, 2003

2 Goldhaber SZ, Tapson VF, for the DVT-FREE Steering Committee. A prospective registry of 5451 patients with ultrasound confirmed deep vein thrombosis.
Am J Cardiol. 2004 Jan 15;93(2):259-62

3 Hansson P-O, Sorbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors
Arch Intern Med. 2000;160(6):769-774.

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Fundamental Principle for Venous Thromboembolism (VTE)

Communication between care providers is an essential part of medical care that influences patients' quality of life and effective disease treatment. Hospitalists can act as leaders to educate both patients and providers regarding appropriate steps to take to improve care transitions, and reduce risks associated with these transitions.

VTE Prevention Collaborative Case Study:

Read about Banner Good Samaritan Hospital, "A Systematic Approach to Reducing Incidences of Hospital-Acquired VTE."

 

This implementation toolkit is sponsored in part by a non-educational sponsorship from sanofi-aventis US, LLC
Disclaimer
The Venous Thromboembolism (VTE) Implementation Toolkit is an online resource for visitors to the Society of Hospital Medicine’s website. All content and links have been reviewed by the VTE Implementation Toolkit Project Team, however the Society of Hospital Medicine does not exercise any editorial control over content associated with the external links that have been made available via this website.

The contributions of Dr. Maynard and his UCSD collaborators in the development of the SHM VTE Prevention Implementation Toolkit and the VTE Prevention Implementation Guide were supported by grant number 1U18HS015826-01 from the Agency for Healthcare Research and Quality (AHRQ). The contents of this product are solely the responsibility of Dr. Maynard and the SHM VTE Project Team, and do not necessarily represent the official view of or imply endorsement by AHRQ or the U.S. Department of Health and Human Services.