Optimal Prevention of Hospital Acquired Venous Thromboe*

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DESCRIPTION (provided by the applicant): Hospital-acquired venous thromboembolism (VTE) is a significant source of morbidity and mortality in hospitalized patients. Improved adherence to proven prophylactic methods should substantially reduce this threat to the safety of hospitalized patients. Our long-term objective is to eliminate preventable hospital acquired VTE in our "model hospital," and assist other institutions to achieve the same objective. Our intervention will maximize the use of appropriate VTE prophylaxis, and minimize VTE risk factors whenever feasible. Specifically, we will: 1) Implement a VTE prophylaxis protocol and a specialized order set which will mandate a clinician assessment of VTE risk level for every patient, and will provide a menu of recommended VTE prophylaxis options for each level of VTE risk. The protocol will mandate this risk-assessment, at a minimum, at the time of admission, and any transfer during the hospitalization. We will enhance the successful implementation of our VTE prophylaxis model with a tiered resource team, using the Institute for Healthcare Improvement model for improvement. We will track the resulting increase in prevalence of appropriate VTE prophylaxis, and the decrease in incidence of hospital-acquired VTE. 2) Create a modifiable toolkit that can be disseminated to health care systems caring for patients at risk of VTE, which will facilitate successful interventions similar to those validated in the "model hospital." The toolkit will follow the Model for Improvement recommended by the Institute for Healthcare Improvement (IHI) in order to guide the formation and operation of multidisciplinary teams within healthcare systems. The toolkit will also include software-based protocols which the teams can use to create and modify VTE prophylaxis order sets based on their own evidence-based conclusions. Relevance: 250,000 patients in United States hospitals require anticoagulation for deep vein thromboses and pulmonary emboli every year, and half of these develop in the hospital. Proven prophylactic regimens which are safe and cost-effective are available, but are routinely underutilized. This project will establish optimal prevention of hospital-acquired VTE, and will produce a toolkit that will allow other institutions do the same, thereby substantially reducing the morbidity, mortality, and cost associated with this problem.