UChicago Medicine Reduces Perioperative Venous Thromboembolism with AHRQ's Toolkit

UChicago Medicine (UCM) reduced venous thromboembolism (VTE) incidence by 30% in the perioperative patient population with the use of AHRQ’s Preventing Hospital-Associated Venous Thromboembolism Toolkit. Using the toolkit’s Framework for Improving VTE Prevention, the Risk and Patient Safety Department established a multidisciplinary VTE taskforce comprised of expertise from patient safety, pharmacy, nursing, clinical providers, therapy services, clinical education, informatics, environmental services, and transportation. The taskforce conducted a literature search of evidence-based best practices for VTE prevention and a gap analysis across the institution for all flagged PSI #12 (Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate) cases. The aims of the taskforce were to strengthen established chemical and mechanical prophylaxis and ambulation processes. Nursing units and surgical services with the largest volume of PSI #12 cases were selected to implement targeted improvements over a 12-month period. The targeted improvements were multifaceted in nature and included, but were not limited to, the following (see Appendix A for a timeline of these improvements):

• Nursing awareness on the importance of adhering to all ordered anticoagulation doses for patients scheduled for a surgical or interventional procedure. Through an awareness campaign, including distribution to a system-wide weekly nursing newsletter, the message to prevent VTE and reduce hospital injuries related to prolonged hospital stays were reinforced.
• Optimized anticoagulation dosing and timing via order set changes in orthopedics and interventional radiology.
• Protocol-driven ambulation initiative based on the Activity Measure for Post-Acute Care (AM-PAC) scores, to standardize nursing-led ambulation when appropriate (AM-PAC ≥ 19) and referrals to physical therapy for ambulation (AM-PAC ≤ 18).
• Collaboration across trauma, orthopedics, neurology, and neurosurgery led to optimization of anticoagulation practices in the trauma patient population, which was implemented through a standardized protocol.
• Requirement of the presence and use of sequential compression devices in all patient rooms in the orthopedic/surgical nursing unit.

The VTE Taskforce received organizational support from risk management and patient safety, therapy services, environmental services, transportation services, and various quality chiefs from surgery, orthopedics, neurosurgery, pharmacy, nursing, medicine, and interventional radiology. While there was a 30% reduction in PSI #12 cases across the institution when comparing calendar year January–July 2022 to January–July 2023, the most visible advances occurred in the services and nursing units selected by the taskforce to implement targeted improvements with a 50% reduction in general surgery, a 57% reduction in orthopedic surgery, and an 80% reduction in the medical surgical nursing unit serving the orthopedic, gynecological, and specialty surgical population. Anecdotally, capacity for physical therapy-driven ambulation was improved, as was multidisciplinary collaboration around this important patient safety issue.

Appendix A: Timeline for Improvements