Patient Safety, 2010

New York Hospitals

May 2010

Between September 2008 and May 2009, AHRQ hosted a series of seven Web conferences about its toolkit, Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. These events were part of an AHRQ Knowledge Transfer project. As a result of the Web conference series, several hospitals from New York changed their policies on caring for patients at risk for venous thromboembolism (VTE).

The AHRQ toolkit is a comprehensive guide to help hospitals and clinicians implement processes to prevent dangerous blood clots. The 60-page guide details how to start, implement, evaluate, and sustain a quality improvement strategy. It includes case studies, as well as forms that clinicians can use. The toolkit advises hospitals to establish VTE prevention protocols to assess patients' risk for hospital-acquired VTEs and select the best method for preventing the condition.

The toolkit encourages hospitals to discard commonly used protocols that assign points to risk factors for VTEs in order to determine the appropriate treatment option. Instead, the guide encourages hospitals to adopt protocols that group patients into three risk categories. Each category is associated with a clear set of recommendations about the most appropriate measures to prevent VTEs. The guide also advises hospitals to provide drug therapy to prevent clots to all patients at moderate or high risk of VTEs.

Massena Memorial Hospital in Massena, New York, did not have a VTE prevention protocol in place at the beginning of the Web conference series. Massena Memorial's Betty MacDonald, RN, reports that her hospital used the information to develop and implement a VTE protocol for the medical, surgical, intensive care, and obstetrics units. A baseline audit of Massena patient charts in November 2008 showed that 25 percent of patients received some form of VTE prevention. By September 2009, patients receiving some form of VTE prevention had increased to 90 percent. MacDonald attributes this improvement to the introduction of the new protocol.

St. Barnabas Hospital in New York City also did not have a VTE prevention protocol prior to participating in the Web conferences. According to Lulu Ibanez, RPA-C, Quality Manager for St. Barnabas, the hospital developed a VTE order set for the medical unit that aligns with the toolkit's recommendations. St. Barnabas has provided in-service training for its residency programs on using the resources.

One of the hospitals that revised an existing VTE prevention protocol is Catskill Regional Medical Center in Harris, New York. According to Lisa Clark, RN, BSN, Clinical Reviewer, Catskill switched from a points-based to a risk-category protocol and now recommends drugs to prevent blood clots for all patients at moderate risk for VTE. The new protocol also expanded the range of medications recommended for patients in this risk group. Catskill now conducts daily real-time reviews of VTE prevention rates. As a result of these efforts, the percent of patients at Catskill receiving some form of mechanical or medical VTE prevention increased from 30 percent in October 2008 to 80 percent in August 2009.

Based on the information presented in the Web conference series, Lawrence Hospital Center in Bronxville, New York, also revised its VTE order set. Originally using a points-based tool, the hospital now uses a protocol that groups patients into three clearly differentiated categories of risk. Michelle Pollack, RN, Performance Improvement Specialist at Lawrence Hospital Center, reports that the protocol includes information about VTE prevention for each risk group and about contraindications.

According to Frederick Cassera, RPh, MBA, Pharmacy Director at Maimonides Medical Center in Brooklyn, New York, significant changes were made to his hospital's VTE prevention protocol after participating in the Web conferences. Maimonides streamlined what had been a fragmented paper-based form and put it online. The hospital also reduced the number of VTE risk categories from four to three and provided clearer prevention recommendations for each category.

Marina Florentino, Quality Management Coordinator for Kingsbrook Jewish Medical Center in New York City, notes that her hospital used the information from the Web conferences to improve the risk assessment component of its existing protocol. Information about contraindications for certain approaches to VTE prevention was added electronically to the order set. The new computerized physician order entry VTE prevention protocol was implemented in the medical and surgical units in September 2009.

The Web conferences were held in partnership with IPRO, New York's Quality Improvement Organization. Gregory Maynard, MD., of the University of California, San Diego, developed the toolkit and presented information during the Web conferences.

Knowledge Transfer Case Study Identifier: KT-CQuIPS-39
AHRQ Products: Partnerships in Implementing Patient Safety
Topic(s): Hospital-Acquired Venous Thromboembolism
Scope: New York

Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/vtguide/

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