Venous Thromboembolism (VTE)
Why VTE Project Key hospital outcome for CMS Value base purchasing Leading cause of sudden death in hospitals Clinical documentation rich with information that is not well used. Balance between bleeding risk and clotting Burdensome clinician documentation for risk assessments Current performance on PSI 12 very high PSI 12 excludes medical patients Need more timely information for improvement
Davies Award Presentation Henry Ford Health System September 12, 2017
Why VTE Project Problem oriented charting enabled use of problem list as input for patient risk without special documentation VTE was test of real time risk scoring in EMR Co developed with IT team, analytics and clinicians Background custom data mart and near real time measure of VTE outcome developed by analytics Redesigned order sets based on guidelines and physician feedback Tracked missed doses, refused doses
Intended Outcomes Improve VTE Measurement Create a timely, accurate VTE measure for inpatients including medial patients Dashboards that can track the VTE trends and pinpoint areas for improvement Improve VTE Risk Assessment Design and integrate an effective VTE risk assessment model into the EHR Automate VTE risk assessment within EHR Improve Reliability of Care Facilitate VTE prevention through developing prophylaxis order sets/visual aids Develop decision support tools like best practice alerts to ensure guideline compliance Improve Outcomes Reduce instances of blood clots/pulmonary embolisms in the hospital Save patients lives, and improve quality of life for them
Introduced New VTE Measurement Model Developed a new VTE Measurement model using problem list charting an medication administration One of the 2016 winner: National Quality Forum s (NQF) measure incubator innovation challenge Better sensitivity compared to PSI 12 Can measure DVT/PE rate for both medical and surgical patients Near Real time (within 24 hours)
Reporting Developed dashboards that shows VTE trends by Location and specific units Daily email of case specific data to physicians and specialty chairs Data marts Every inpatient in the ehr (280k+) VTE prophylaxis VTE Treatment Dashboards to look at missed/refused medical VTE Prophylaxis
Built VTE Prophylaxis and Risk into Patient list 1 Check if Patient is high risk for getting a blood clot 2 Check to see if high risk patients receiving medical thromboprophylaxis 3 Check to ensure there is a medical contraindication to not receive a medical prophylaxis if at high risk for VTE
Misses/Refused Prophylaxis Reporting and Education Statistical analysis showed a clear relationship between missing prophylaxis and risk of getting a clot Focus on patient and nurse education to reduce avoidable miss/refusals Dashboards to continuously monitor VTE prophylaxis miss/refusals Case Henry Ford West Bloomfield:
2.5 2 Outcomes Trends (VTE/1,000 patient days) Missed/Refused Medical Prophylaxis Reporting Started Henry Ford West Bloomfield: Patient and nurse education to reduce misses/refused Padua tool pilot use in Henry Ford Hospital 1.5 1 0.5 0 Introduced new measurement model Risk Assessment tool (Padua) developed in EHR Continuous Monitoring VTE Rate/1000 Patient Days 6 per. Mov. Avg. (VTE Rate/1000 Patient Days)
Outcomes Facts: Studies suggest 30% mortality within 30 days following a VTE ~20% of survivors experience lifelong complications AHRQ 2013 estimated $8,000 additional hospital costs to treat VTEs Additional $14,000 17,000 additional costs for health plans Outcomes: The decrease is equivalent to ~180 less instances of VTEs per year Equivalent to 54 lives saved annually $1.44 million in direct costs savings annually Up to $3 million in savings for the system annually