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

Abstract

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. 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. 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). The four-pillar initiative structure implemented was successful in reducing postoperative VTE rates, reducing costs and lowering hospital length of stay.