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Reduction in Venous Thromboembolism Events: Trauma Performance Improvement and Loop Closure Through Participation in
David A Machado-Aranda1, Jill L Jakubus1, Wendy L Wahl2
1Division of Acute-Care Surgery, University of Michigan, Ann Arbor, MI.
Background:
The Michigan Trauma Quality Improvement Program (MTQIP) is a collaborative quality initiative sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network (BCBSM/BCN). The MTQIP benchmark reports identified our trauma center as a high outlier for venous thromboembolism (VTE) episodes. This study outlines the performance improvement (PI) process used to reduce the rate of VTE using MTQIP infrastructure.
Study Design:
Trauma patients admitted for > 24 hours, with an Injury Severity Score (ISS) ≥ 5, were included in this study. We performed a preliminary analysis examining prophylaxis drug type to VTE, adjusted by patient confounders and timing of first dose, using MTQIP data abstracted for our hospital. It showed that patients receiving enoxaparin had a VTE rate that was half that of those receiving unfractionated heparin (odds ratio 0.46, 95% CI 0.25 to 0.85). Guided by these results, we produced the following plan: consolidation to single VTE prophylaxis agent and dose, focused education of providers, initiation of VTE prophylaxis for all patients-with clear exception rules-and dose withholding minimization. Results were monitored using the MTQIP platform.
Results:
After implementation of our focused PI plan, the VTE rate decreased from 6.2% (n = 36/year) to 2.6% (n = 14/year). Our trauma center returned to average performance status within MTQIP.
Conclusions:
Participation in MTQIP provided identification of trauma center outlier status for the outcome of VTE. Analysis of MTQIP data allowed creation of a local action plan. The MTQIP infrastructure supported execution and monitoring of the action plan consistent with loop-closure practices, as advocated by the American College of Surgeons Committee on Trauma, and a positive performance improvement result was achieved with VTE reduction.
Insights
Implementing a targeted performance improvement plan significantly reduced venous thromboembolism (VTE) rates in trauma patients. This initiative successfully brought the trauma center back to average performance within the Michigan Trauma Quality Improvement Program (MTQIP).
Area of Science:
- Trauma care quality improvement
- Venous thromboembolism (VTE) prevention
- Healthcare performance monitoring
Background:
- The Michigan Trauma Quality Improvement Program (MTQIP) identified a specific trauma center as a high outlier for venous thromboembolism (VTE) episodes.
- This necessitated a focused performance improvement (PI) initiative to address and reduce VTE rates.
Purpose of the Study:
- To outline the performance improvement process utilized to decrease the incidence of VTE within a trauma center.
- To leverage the MTQIP infrastructure for data analysis, action plan development, and outcome monitoring.
Main Methods:
- Analysis of MTQIP data for trauma patients (admitted > 24 hours, Injury Severity Score ≥ 5) to identify risk factors for VTE.
- Preliminary analysis indicated lower VTE rates with enoxaparin compared to unfractionated heparin (OR 0.46).
- Implementation of a PI plan including VTE prophylaxis standardization, provider education, and minimized dose withholding, monitored via MTQIP.
Main Results:
- The VTE rate decreased significantly from 6.2% (36/year) to 2.6% (14/year) after the PI plan implementation.
- The trauma center's performance status for VTE returned to the average level within the MTQIP benchmarks.
Conclusions:
- MTQIP participation was crucial in identifying the trauma center's outlier status for VTE.
- Analysis of MTQIP data facilitated the creation and execution of an effective local action plan for VTE reduction.
- The study demonstrated successful performance improvement and VTE reduction through a structured, data-driven approach.
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