Evaluation of an institutional project to improve venous thromboembolism prevention

Christina A. Minami, Anthony D. Yang, Mila Ju, Eckford Culver, Kathryn Seifert, Lindsey Kreutzer, Terri Halverson, Kevin J. O'Leary, Karl Y. Bilimoria

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

BACKGROUND: Northwestern Memorial Hospital (NMH) was historically a poor performer on the venous thromboembolism (VTE) outcome measure. As this measure has been shown to be flawed by surveillance bias, NMH embraced process-of-care measures to ensure appropriate VTE prophylaxis to assess healthcare-associated VTE prevention efforts. OBJECTIVE: To evaluate the impact of an institution-wide project aimed at improving hospital performance on VTE prophylaxis measures. DESIGN: A retrospective observational study. SETTING: NMH, an 885-bed academic medical center in Chicago, Illinois. PATIENTS: Inpatients admitted to NMH from January 1, 2013 to May 1, 2013 and from October 1, 2014 to April 1, 2015 were eligible for evaluation. INTERVENTION: Using the define-measure-analyze-improve-control (DMAIC) process-improvement methodology, a multidisciplinary team implemented and iteratively improved 15 data-driven interventions in 4 broad areas: (1) electronic medical record (EMR) alerts, (2) education initiatives, (3) new EMR order sets, and (4) other EMR changes. MEASUREMENTS: The Joint Commission's 6 core measures and the Surgical Care Improvement Project (SCIP) SCIP-VTE-2 measure. RESULTS: Based on 3103 observations (1679 from January 1, 2013 to May 1, 2013, and 1424 from October 1, 2014 to April 1, 2015), performance on the core measures improved. Performance on measure 1 (chemoprophylaxis) improved from 82.5% to 90.2% on medicine services, and from 94.4% to 97.6% on surgical services. The largest improvements were seen in measure 4 (platelet monitoring), with a performance increase from 76.7% adherence to 100%, and measure 5 (warfarin discharge instructions), with a performance increase from 27.4% to 88.8%. CONCLUSION: A systematic hospital-wide DMAIC project improved VTE prophylaxis measure performance. Sustained performance has been observed, and novel control mechanisms for continued performance surveillance have been embedded in the hospital system. Journal of Hospital Medicine 2016;11:S29–S37.

Original languageEnglish (US)
Pages (from-to)S29-S37
JournalJournal of Hospital Medicine
Volume11
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Fingerprint

Venous Thromboembolism
Electronic Health Records
Hospital Medicine
Process Assessment (Health Care)
Chemoprevention
Warfarin
Observational Studies
Inpatients
Blood Platelets
Retrospective Studies
Joints
Medicine
Outcome Assessment (Health Care)
Delivery of Health Care
Education

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Minami, C. A., Yang, A. D., Ju, M., Culver, E., Seifert, K., Kreutzer, L., ... Bilimoria, K. Y. (2016). Evaluation of an institutional project to improve venous thromboembolism prevention. Journal of Hospital Medicine, 11, S29-S37. https://doi.org/10.1002/jhm.2663

Evaluation of an institutional project to improve venous thromboembolism prevention. / Minami, Christina A.; Yang, Anthony D.; Ju, Mila; Culver, Eckford; Seifert, Kathryn; Kreutzer, Lindsey; Halverson, Terri; O'Leary, Kevin J.; Bilimoria, Karl Y.

In: Journal of Hospital Medicine, Vol. 11, 01.12.2016, p. S29-S37.

Research output: Contribution to journalReview article

Minami, CA, Yang, AD, Ju, M, Culver, E, Seifert, K, Kreutzer, L, Halverson, T, O'Leary, KJ & Bilimoria, KY 2016, 'Evaluation of an institutional project to improve venous thromboembolism prevention', Journal of Hospital Medicine, vol. 11, pp. S29-S37. https://doi.org/10.1002/jhm.2663
Minami, Christina A. ; Yang, Anthony D. ; Ju, Mila ; Culver, Eckford ; Seifert, Kathryn ; Kreutzer, Lindsey ; Halverson, Terri ; O'Leary, Kevin J. ; Bilimoria, Karl Y. / Evaluation of an institutional project to improve venous thromboembolism prevention. In: Journal of Hospital Medicine. 2016 ; Vol. 11. pp. S29-S37.
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abstract = "BACKGROUND: Northwestern Memorial Hospital (NMH) was historically a poor performer on the venous thromboembolism (VTE) outcome measure. As this measure has been shown to be flawed by surveillance bias, NMH embraced process-of-care measures to ensure appropriate VTE prophylaxis to assess healthcare-associated VTE prevention efforts. OBJECTIVE: To evaluate the impact of an institution-wide project aimed at improving hospital performance on VTE prophylaxis measures. DESIGN: A retrospective observational study. SETTING: NMH, an 885-bed academic medical center in Chicago, Illinois. PATIENTS: Inpatients admitted to NMH from January 1, 2013 to May 1, 2013 and from October 1, 2014 to April 1, 2015 were eligible for evaluation. INTERVENTION: Using the define-measure-analyze-improve-control (DMAIC) process-improvement methodology, a multidisciplinary team implemented and iteratively improved 15 data-driven interventions in 4 broad areas: (1) electronic medical record (EMR) alerts, (2) education initiatives, (3) new EMR order sets, and (4) other EMR changes. MEASUREMENTS: The Joint Commission's 6 core measures and the Surgical Care Improvement Project (SCIP) SCIP-VTE-2 measure. RESULTS: Based on 3103 observations (1679 from January 1, 2013 to May 1, 2013, and 1424 from October 1, 2014 to April 1, 2015), performance on the core measures improved. Performance on measure 1 (chemoprophylaxis) improved from 82.5{\%} to 90.2{\%} on medicine services, and from 94.4{\%} to 97.6{\%} on surgical services. The largest improvements were seen in measure 4 (platelet monitoring), with a performance increase from 76.7{\%} adherence to 100{\%}, and measure 5 (warfarin discharge instructions), with a performance increase from 27.4{\%} to 88.8{\%}. CONCLUSION: A systematic hospital-wide DMAIC project improved VTE prophylaxis measure performance. Sustained performance has been observed, and novel control mechanisms for continued performance surveillance have been embedded in the hospital system. Journal of Hospital Medicine 2016;11:S29–S37.",
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AU - Kreutzer, Lindsey

AU - Halverson, Terri

AU - O'Leary, Kevin J.

AU - Bilimoria, Karl Y.

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N2 - BACKGROUND: Northwestern Memorial Hospital (NMH) was historically a poor performer on the venous thromboembolism (VTE) outcome measure. As this measure has been shown to be flawed by surveillance bias, NMH embraced process-of-care measures to ensure appropriate VTE prophylaxis to assess healthcare-associated VTE prevention efforts. OBJECTIVE: To evaluate the impact of an institution-wide project aimed at improving hospital performance on VTE prophylaxis measures. DESIGN: A retrospective observational study. SETTING: NMH, an 885-bed academic medical center in Chicago, Illinois. PATIENTS: Inpatients admitted to NMH from January 1, 2013 to May 1, 2013 and from October 1, 2014 to April 1, 2015 were eligible for evaluation. INTERVENTION: Using the define-measure-analyze-improve-control (DMAIC) process-improvement methodology, a multidisciplinary team implemented and iteratively improved 15 data-driven interventions in 4 broad areas: (1) electronic medical record (EMR) alerts, (2) education initiatives, (3) new EMR order sets, and (4) other EMR changes. MEASUREMENTS: The Joint Commission's 6 core measures and the Surgical Care Improvement Project (SCIP) SCIP-VTE-2 measure. RESULTS: Based on 3103 observations (1679 from January 1, 2013 to May 1, 2013, and 1424 from October 1, 2014 to April 1, 2015), performance on the core measures improved. Performance on measure 1 (chemoprophylaxis) improved from 82.5% to 90.2% on medicine services, and from 94.4% to 97.6% on surgical services. The largest improvements were seen in measure 4 (platelet monitoring), with a performance increase from 76.7% adherence to 100%, and measure 5 (warfarin discharge instructions), with a performance increase from 27.4% to 88.8%. CONCLUSION: A systematic hospital-wide DMAIC project improved VTE prophylaxis measure performance. Sustained performance has been observed, and novel control mechanisms for continued performance surveillance have been embedded in the hospital system. Journal of Hospital Medicine 2016;11:S29–S37.

AB - BACKGROUND: Northwestern Memorial Hospital (NMH) was historically a poor performer on the venous thromboembolism (VTE) outcome measure. As this measure has been shown to be flawed by surveillance bias, NMH embraced process-of-care measures to ensure appropriate VTE prophylaxis to assess healthcare-associated VTE prevention efforts. OBJECTIVE: To evaluate the impact of an institution-wide project aimed at improving hospital performance on VTE prophylaxis measures. DESIGN: A retrospective observational study. SETTING: NMH, an 885-bed academic medical center in Chicago, Illinois. PATIENTS: Inpatients admitted to NMH from January 1, 2013 to May 1, 2013 and from October 1, 2014 to April 1, 2015 were eligible for evaluation. INTERVENTION: Using the define-measure-analyze-improve-control (DMAIC) process-improvement methodology, a multidisciplinary team implemented and iteratively improved 15 data-driven interventions in 4 broad areas: (1) electronic medical record (EMR) alerts, (2) education initiatives, (3) new EMR order sets, and (4) other EMR changes. MEASUREMENTS: The Joint Commission's 6 core measures and the Surgical Care Improvement Project (SCIP) SCIP-VTE-2 measure. RESULTS: Based on 3103 observations (1679 from January 1, 2013 to May 1, 2013, and 1424 from October 1, 2014 to April 1, 2015), performance on the core measures improved. Performance on measure 1 (chemoprophylaxis) improved from 82.5% to 90.2% on medicine services, and from 94.4% to 97.6% on surgical services. The largest improvements were seen in measure 4 (platelet monitoring), with a performance increase from 76.7% adherence to 100%, and measure 5 (warfarin discharge instructions), with a performance increase from 27.4% to 88.8%. CONCLUSION: A systematic hospital-wide DMAIC project improved VTE prophylaxis measure performance. Sustained performance has been observed, and novel control mechanisms for continued performance surveillance have been embedded in the hospital system. Journal of Hospital Medicine 2016;11:S29–S37.

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