Today, Pulmonary Embolism (PE) occurs more frequently in hospitalized medical patients than in surgical patients and represents a leading cause of sudden death during hospitalizations. However, only about 40 percent of hospitalized medical patients at high risk for Venous Thromboembolism (VTE) receive appropriate thromboprophylaxis.
Intermountain Healthcare http://intermountainhealthcare.org in Utah, was one of eight U.S. health systems recognized by CDC www.cdc.gov for implementing protocols to reduce the rate of VTE which is characterized as Deep Vein Thrombosis (DVT) and/or PE during the patient’s hospitalization.
CDC awarded Intermountain their 2015 HA-VTE Prevention Champion Award for their ongoing research and best practice protocols used within Intermountain to help prevent hospitalized patients from developing blood clots.
Seven other health systems and hospitals were also recognized for trying to reduce the rate of VTE or blood clots. The awardees range from a small community hospital to some of the country’s largest health systems located in both rural and urban areas.
These systems included Mayo Clinic www.mayoclinic.org, University of California Health Center for Quality and Innovation, http://health.universityofcalifornia.edu/innovation-center University of Wisconsin Health www.uwhealth.org, Northwestern Memorial Hospital www.nm.org/location/northwestern-memorial-hospital, Johns Hopkins Hospital www.hopkinsmedicine.org, Harborview Medical Center www.uwmedicine.org/harborview, and Hutchinson Regional Medical Center www.hutchregional.com.
To reduce the rate of VTE, the facilities used technology such as electronic risk assessment and clinical decision support tools and alerts. They also provided real-time feedback, scorecards, and dashboards for providers and organizations to monitor performance and to identify areas for improvement.
In Intermountain Healthcare’s case, the VTE Reduction Initiative (VRI) was implemented at two large metropolitan teaching hospitals that included one hospitalist group. The VRI consisted of three main components.
First, each medical patient was classified daily as either at high-risk for VTE or not high-risk which was done in two stages. To begin, an electronic VTE Risk Assessment Module interrogated the EMR and generated a VTE risk score for each hospitalized medical patient. Next, another electronic tool interrogated the medical administration record for appropriate chemoprophylaxis or for therapeutic anticoagulation.
During the intervention period, if a patient was at high risk for VTE and not receiving appropriate chemoprophylaxis, an electronic VTE risk alert was sent to the attending hospitalist in conjunction with an electronic message sent to the EMR.
The hospitalist could interface with the electronic alert system to document any reason why the treatment needed to be withheld. At that point, the daily alert would be turned off for 5 days, and the hospitalist would be credited with having appropriately dispensed VTE prophylaxis.
Go to www.cdc.gov/ncbddd/dvt/ha-vte-challenge.html to view more information on the CDC awardees.