Reduction of Venous Thromboembolism (VTE) in Hospitalized Patients: Aligning Continuing Education With Interprofessional Team-Based Quality Improvement in an Academic Medical Center

Pingleton, Susan K. MD; Carlton, Elizabeth RN, MSN; Wilkinson, Samaneh; Beasley, Jeffrey DO; King, Theresa MD; Wittkopp, Chris; Moncure, Michael MD; Williamson, Tim MD

doi: 10.1097/ACM.0b013e3182a4aa51
Innovation Reports

Problem: Despite clear prophylactic guidelines and national quality emphasis, a minority of hospitalized patients receive appropriate prophylaxis for venous thromboembolism (VTE). Data from the University of Kansas Hospital (KUH) revealed an unacceptably high incidence of VTE.

Approach: The authors aligned continuing education with quality improvement through formation of an interprofessional, multidisciplinary team to develop strategic educational and system operational plans to decrease VTE incidence. The authors reviewed 261 charts with the secondary diagnosis of VTE for identification of themes or causes of VTE to develop multipronged educational and system-based action plans. The authors reviewed a “menu” of evidence-based content delivery techniques to develop the educational plan. Multiple noneducational adjunct system strategies were also developed and implemented.

Outcomes: After implementation of all specific action plans, the KUH VTE incidence decreased 51% from November 2010 to June 2012 (from 12.68 to 6.10 per 1,000 patients). Insertion of peripherally inserted central catheters, a common identified theme, dropped from almost 360 insertions in December of 2010 to less than 200 insertions in April 2012.

Next Steps: Aligning continuing education with quality improvement through an interprofessional, multidisciplinary team approach was associated with a decrease in VTE. The authors describe challenges and lessons learned to inform implementation of similar quality-improvement-driven continuing education initiatives elsewhere. Challenges included time, resources, multiple service lines, and departments with variable acceptance of data. Lessons learned included the value of leadership commitment, interprofessional team work, assessing individual data, expertise of continuing education, using multiple educational methods, and the need for overall champions.

Dr. Pingleton is Joy McCann Professor of Women in Medicine and Science and associate dean of continuing education and professional development, University of Kansas School of Medicine, Kansas City, Kansas.

Ms. Carlton is director of quality, Department of Nursing, University of Kansas Hospital, Kansas City, Kansas.

Ms. Wilkinson is assistant director of pharmacy inpatient services, University of Kansas Hospital, Kansas City, Kansas.

Dr. Beasley is assistant professor of medicine, University of Kansas School of Medicine, Kansas City, Kansas.

Dr. King is assistant professor of medicine, University of Kansas School of Medicine, Kansas City, Kansas.

Ms. Wittkopp is director of quality outcomes, Organizational Improvement Office, University of Kansas Hospital, Kansas City, Kansas.

Dr. Moncure is medical director of trauma and professor of surgery, University of Kansas School of Medicine, Kansas City, Kansas.

Dr. Williamson is associate professor of pulmonary and critical care medicine, University of Kansas School of Medicine, Kansas City, Kansas.

Acknowledgments: The authors would especially thank and acknowledge the assistance of David Davis, MD, and Nancy Davis, PhD, in the strategic thinking and support of this project. The authors also gratefully acknowledge the Association of American Medical Colleges’ Aligning Education for Quality project which was instrumental in the alignment of continuing education and quality improvement at the University of Kansas for this project.

Funding/Support: None.

Other disclosures: None.

Ethical approval: This study was approved by the University of Kansas human subjects committee.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A151.

Correspondence should be addressed to Dr. Pingleton, University of Kansas School of Medicine, Mail Stop 4001, 3901 Rainbow Blvd., Kansas City, KS 66160; e-mail: Spinglet@kumc.edu.

© 2013 by the Association of American Medical Colleges