Improving Venous Thromboembolism Prophylaxis

Study Overview
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Brief Summary
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Preventing the formation of blood clots in the veins so they do not injure leg veins or travel to the lungs, also called venous thromboembolism prophylaxis (VTE-P) is an essential component of safe in-patient care, yet it is deployed sub-optimally in many hospitals, including The investigators own. Two prior VTE-P improvement projects were completed at Mayo Clinic hospitals, one in the Department of Medicine, and the other in selected divisions of the Department of Surgery. Both projects resulted in marked improvement in the percentage of patients receiving appropriate VTE-P. This project seeks to utilize the lessons learned from these two pilots along with known best practices for &quot;spreading&quot; to deploy methods that enhance VTE-P to the entire hospitalized population. The investigators seek appropriate VTE-P rates exceeding 95%.

Detailed Description
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Venous thromboembolism prophylaxis (VTE-P) is an essential component of safe in-patient care, yet it is deployed sub-optimally in many hospitals, including our own. Two prior VTE-P improvement projects were completed at Mayo Clinic hospitals, one in the Department of Medicine, and the other in selected divisions of the Department of Surgery. Both projects resulted in marked improvement in the percentage of patients receiving appropriate VTE-P. This project seeks to utilize the lessons learned from these two pilots along with known best practices for &quot;spreading&quot; to deploy methods that enhance VTE-P to the entire hospitalized population. The investigators seek appropriate VTE-P rates exceeding 95%. This began as a quality improvement project. The investigators have taken baseline measures of VTE-P rates in our hospitals, intervened with various electronic prompts to use appropriate VTE-P, and have and will re-measure VTE-P rates. The investigators intend to present and publish our methods and results so that lessons learned may be shared and applied elsewhere.

Official Title
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Spreading and Improving DVT Prophylaxis at Mayo Clinic (DVT-P-Spread)

Conditions
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Venous Thromboembolism, Delivery of Health Care, Quality Improvement

Intervention / Treatment
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* Other: VTE-P Tollgate
* Other: BLAZE Pop up
* Other: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inpatients with age > 17 years old Exclusion Criteria: Outpatients Inpatients with age less than or equal to 17 years old

Ages Eligible for Study
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Minimum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Order Set<br>Insertion of VTE-P Order Set tollgate in all active admission and transfer orders. | Other: VTE-P Tollgate<br>* Add VTE-P tollgate order set that requires a decision regarding VTE-P for every patient admitted or transferred in our hospital system<br>|
| Experimental: Clinical Decision Support Pop-up<br>Deploy rules-based pop-up that reminds ordering clinicians when patients do not have an active VTE-P plan. | Other: BLAZE Pop up<br>* Develop and deploy a rules-based popup that reminds prescribers interfacing with the orders system when a patient does not have an active VTE-P plan.<br>|
| Active Comparator: Usual Care<br>Usual care, without the experimental additions | Other: Usual Care<br>* No addition to the baseline system for care<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| % of in patients with an appropriate VTE prophylaxis plan | The investigators will measure the number of patients in a statistically valid random sample of hospitalized patients who have a VTE-prophylaxis plan consistent with current recommendations. | Baseline to 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinically significant complications of VTE-P anticoagulant therapy | The investigators will determine the rate of bleeding complications in inpatients using a statistically valid random sample of hospitalized patients. The investigators will also determine the rate of procedure delays due to VTE-P related anticoagulation. | baseline to 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Venous Thromboembolism, Delivery of Health Care, Quality Improvement, Evidence-Based Practice