Multimodal quality improvement project on reducing hospital perioperative thromboembolic events (Patient Safety Indicator-12).

BACKGROUND: Venous thromboembolism (VTE), which includes both pulmonary embolism and deep vein thrombosis, is a common yet significant postoperative complication. Patient Safety Indicator (PSI)-12 was introduced by Centers for Medicare & Medicaid Services and Agency for Healthcare Research and Quality to track this potentially preventable complication. We initiated a multifaceted process to reduce our postoperative VTE rates through a four-pillar initiative structure. Our objective was to assess the impact of a multifaceted process and quality improvement initiative on the rate of postoperative VTE at an academic medical centre. METHODS: Our study was conducted at Duke University Medical Center. Our intervention consisted of a four-pillar initiative structure: building a consensus on appropriate VTE prophylaxis through surgical specialty champions; incorporating VTE prophylaxis recommendations in the provider electronic health record workflow; using a measurement dashboard; and reviewing all individual postoperative VTE cases with clinical champions. We collected pre-intervention data on PSI-12 rates for 12 months ending in September 2019, initiated improvement strategies in September 2020 and reviewed results of our improvement strategies at the end of December 2021 for a 15-month timespan. RESULTS: In 2019, we identified 94 postoperative VTE events per 13 522 adult surgical discharges for a rate of 0.695%. In 2021, we identified 71 postoperative VTE events per 12 292 adult surgical discharges for a rate of 0.578%. This represents a gross reduction in postoperative VTE event rate by 23 when comparing our pre-intervention and post-intervention timeframes which was both a clinically and statistically significant difference (p<0.0001, 95% CI: 0.1050 to 0.1288). CONCLUSIONS: The four-pillar initiative structure implemented was successful in reducing postoperative VTE rates, reducing costs and lowering hospital length of stay.

Duke Scholars

Author Momen Mohammed Wahidi Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author Maragatha Kuchibhatla Biostatistics & Bioinformatics, Division of Biostatistics

Author Thomas Lee Ortel Medicine, Hematology

Author Jonathan Gregory Bae Medicine, Hospital Medicine

Author Devdutta Gangadhar Sangvai Family Medicine and Community Health

Author Andrew M. Peseski Medicine, Hematology