Initiating a Standard Venous Thromboembolism Prophylaxis Order Set Designed to Improve Patient Outcomes at Los Angeles County+University of Southern California

Abstract

Improving patient safety is vital for all hospitals due to increasing public reporting and pay-for-performance reimbursement. Venous thromboembolism (VTE) remains a leading cause of preventable mortality accounting for 5 per cent of inpatient deaths. The purpose of this study was to outline the process of implementing standard VTE prophylactic order sets in a 600-bed academic safety net hospital and assess the resulting change in patient outcomes. Outcomes were assessed by comparing the rate that eligible inpatients receive VTE prophylaxis and the rate of preventable VTE's compared with total VTE's. From 2011 to 2015, random samples of 60 Los Angeles County+University of Southern California inpatients were generated monthly to examine compliance rates by comparing ICD-9 diagnostic codes to ordered VTE prophylaxis. All inpatient VTE's are retrospectively analyzed. Baseline-ordered VTE prophylaxis was 37 per cent in 2010. The target of 85 per cent was exceeded by the second quarter of 2012 to 2013 when compliance reached 88 per cent, a 51 per cent increase from baseline (P < 0.01). These results suggest VTE protocols are effective though standardization across service lines is often difficult. Despite these challenges, after implementing standard order sets, we saw compliance increase significantly. Ongoing analysis to determine whether VTE rates have significantly decreased is presently underway.