Johns Hopkins Hospital’s journey to improved DVT prevention took several years. However, we hope that by sharing our experience, we can help your organization to quickly adopt solutions that have a proven record.
Stage 1—Paper Order Sets
In 2005, the Center for Innovation identified a collaborative hospital team that included a hematologist, pharmacist, trauma surgeon and a nurse to find new ways of thinking systematically about VTE prevention. The VTE Collaborative developed paper-based VTE risk-stratification order-set tools, and then worked with clinical units to initiate a hospital-wide effort to optimize prophylaxis.
Within a year, the rate of risk-appropriate VTE prophylaxis at Hopkins Hospital nearly tripled to 65 percent. The Center for Innovation has made these paper order sets free for your use and modification. Contact us to obtain copies.
Stage 2—Computerized Order Sets
Despite the success of the paper order sets, consistent use of the forms was hard to maintain. With time, use of the tool dropped off on many clinical units. So the VTE Collaborative sought to transition from paper to an electronic system, featuring the utilization of computerized provider order-entry (CPOE). Algorithms invented by the VTE Collaborative were hardwired into the CPOE system to automate the risk-stratification process and make clinical prophylaxis recommendations based on risk levels. To ensure compliance, the system has been programmed to require completion by providers. However, this solution has added minimal burden to workflow by pulling many necessary pieces of patient information from the patient’s electronic medical record.
Compliance with national best practice guidelines for VTE prophylaxis is now in the upper 90-percentiles across the entire hospital, and significantly higher than national and state averages. We have seen our VTE rates fall concomitantly. In one year, these efforts are estimated to have prevented more than 80 DVTs from occurring—which translates to eight fewer deaths and avoiding costs of more than $650,000.
Stage 3—Comprehensive Reporting and Monitoring
The VTE Collaborative teamed with data analysts to produce metrics on the hospital’s performance in this area. These metrics are incorporated into system-level dashboards, and they also provide robust information to providers and quality improvement teams.
It’s now possible at Hopkins Hospital to electronically analyze patient risk factors, type of prophylaxis administered, and outcome measures for almost any hospital admission. Report cards are currently generated on a monthly basis at the functional unit level, by service, as well as across the hospital.