What is your hospital doing to mark DVT Awareness Month this year? Consider that last year a Virginia hospital used this occasion to educate their staff on VTE, which encompasses both DVT and PE. This training was the first step in the implementation of a multidisciplinary, hospital-wide process that resulted in the vast majority of patients receiving proper preventive treatment of this common killer.
According to the Society of Critical Care Medicine, VTE is the No. 1 preventable cause of hospital-associated death for medical inpatients. Most hospitals are struggling to decrease the number of DVTs and PEs in their patient population by teaching or reminding staff to check for risk factors in each patient and, if necessary, provide VTE prophylaxis. While this seems like a simple solution, anyone who’s currently struggling to turn the numbers around this way can assure you that it is an uphill battle. The good news is that Carilion Medical Center in Roanoke, Va., may have found a key to winning that battle.
First Steps toward Improvement
Carilion Medical Center is 625-bed tertiary care facility that typically operates at peak census. With a level-one trauma center and a separate building housing the women’s and children’s hospital, Carilion offers every kind of care except burn treatment and full organ transplants.
“We recognized that VTE prophylaxis is a very important area and that we had not addressed it,” says James Franko, MD, FACP, medical director, General Medicine and Hospitalist Services.
Carilion’s first attempt to tackle the problem was not effective, but it laid the groundwork for later success.
“In April of 2004 we began working with a committee, conducting an investigation to see how frequently patients were receiving VTE prophylaxis,” recalls Dr. Franko. “We found that it was about 30%, based on patient population where more than 80% met the criteria for receiving this prophylaxis.”
The committee then broke down the data to examine who was ordering the VTE prophylaxis and found that there were three groups of physicians.
“There were those who almost always ordered the treatment, including our trauma surgeons,” says Dr. Franko. “Then there were those who did it sometimes and another group of those who never ordered it. We saw that this was obviously a good opportunity for education.”
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The chart used by Carilion Medical Center to assess patients for VTE. The chart is included in the patient’s medical chart and leads nursing staff through simple questions to determine whether or not the patient should receive VTE prophylaxis.
Initial Research and Planning
In summer 2004, the group implemented a pilot program for screening every single patient on one floor of the hospital—a floor where physicians were predominantly hospitalists. The pilot involved including an information sheet on each medical chart with a list of VTE risk and exclusion criteria. The results: “We saw only a modest increase in prophylaxis,” says Dr. Franko.
So he pushed to find a better way to focus attention on VTE prophylaxis, this time using the channel that Carilion Medical Center has in place to address quality improvement issues.
“Someone can pitch an idea to our Quality Council and ask for a charter team,” explains Kris Peters, RN, human resources education consultant for Carilion Medical Center. “That team is given a time frame and asked to perform research and make recommendations. We have a charter team for pneumonia, for heart failure, for MCI, … that’s worked well for us.”
In fall 2004, Carilion’s Quality Council commissioned a new charter team and gave them the mission of increasing the percentage of patients receiving VTE prophylaxis. The team consisted of Dr. Franko and other physicians, nursing staff, a pharmacist, researchers, a staff member from the medical records department, secretaries, and—as a late addition—Peters.