VTE Awareness Month

The Hospitalist. 2009 April;2009(04):

April 20, 2009 | The Hospitalist

Most hospital patients have at least one of these VTE risk factors, which are sorted into three categories:

Stasis: conditions such as advanced age, immobility, paralysis, or stroke;
Hypercoaguability: smoking, pregnancy, cancer, or sepsis; and
Endothelial damage: surgery, prior VTE, central lines, or trauma.

Because the potential VTE risk is so high in hospital patients, the assessment must go hand in hand with prophylaxis, says Dr. Maynard and other hospitalists working with VTE.

Recent research has shown that prescribing medications to prevent VTE before it begins is safe, effective, and cost-effective.

The Hospitalist’s Role

One of the goals of SHM’s VTE Prevention Collaborative is to get physicians to order a shot in the abdomen once per day for hospitalized VTE patients.

The responsibility for VTE risk assessment and prevention often falls to hospitalists. In its online VTE Resource Room, SHM provides information for hospitalists working to assess and prevent VTE in their patients. It also provides a complete toolkit for hospitalists interested in addressing VTE prevention systematically throughout their hospitals. The toolkit is part of a comprehensive VTE Prevention Collaborative, which provides real-world mentoring and materials to hospitalists as they develop VTE monitoring and prevention programs.

“In 2005, when SHM set up the Quality Improvement resource room, we began with VTE prophylaxis,” Dr. Stein says. “VTE is the No. 1 cause of preventable death in hospitals, and preventing it is a fundamentally simple thing for hospitalists to do. We’re trying to get physicians to order a shot in the abdomen once a day. … If we can’t do that, we’re in trouble. On the flipside, if we can figure that out, we can derive mechanisms that we can apply to more complex problems in care.”

VTE PREVENTION COLLABORATIVE:

The Model Program for Quality Improvement

As any successful hospitalist will tell you, technical and medical expertise are only half the formula for a safe, efficient practice. The other half is expertise in interpersonal collaboration and program management.

That’s the lesson Kathleen Kerr, SHM senior advisor and senior research analyst at the University of California San Francisco Department of Medicine, learned as one of the program leaders of SHM’s VTE Prevention Collaborative (VTEPC). The VTEPC pairs hospitalists who are starting VTE prevention initiatives with mentors who provide support and advice.

“Hospitalists across the country really found value in getting guidance from experienced mentors,” Kerr explains. “The hospitalists who are starting these VTE prevention programs are some of the brightest and innovative in their practices, but they still benefit from mentors who can advise them. Project management, leadership, the interpersonal aspects of guiding a multidisciplinary team—these are challenges that can be especially daunting for a new hospitalist who is looking to lead a hospitalwide quality improvement effort.”

Launched in 2007, the VTEPC mentorship program has been a success. The program already has a full roster of participants for this year, and plans are in the works to expand in the coming months.

Kerr recommends SHM members interested in participating should visit the online VTE Resource Room for program updates.

The mentorship program’s positive impact has encouraged SHM to explore new quality improvement issues.

“Our success here should not be limited to VTE prevention,” Kerr explains. “We’re looking forward to using this model to overcome other challenges facing hospitalists and their patients.”—BS

Together with SHM, Drs. Stein and Maynard have pioneered a two-pronged approach known as “measure-vention.” The underlying principal of measure-vention is that monitoring for VTE risk in real time can empower hospital staff to remedy issues in real time. In most hospitals, VTE risk can only be measured retrospectively through quality improvement data, which can take months to collect.