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• Filed under: Quality, Features, Cover Story

• Keywords: protocol, risk, tool, DVT, innovation, prophylaxis

Prevention Prowess

From: The eWire, 1.27.2010

by Christopher Guadagnino, PhD

Three medical centers have been nationally recognized for innovative approaches to preventing DVT and its potentially fatal complications. Central to each of the prevention strategies is a risk assessment tool that is easy to use, built directly into routine care, and linked directly to guideline-recommended choices for prophylaxis.

The North American Thrombosis Forum (NATF), in coordination with the pharmaceutical company Eisai Inc., recognized the following centers with the first DVTeamCare Hospital Award:

• The University of California at San Diego Medical Center was awarded as a representative of medical centers with more than 200 beds. The hospital embedded its VTE prevention protocol into admission, transfer, and perioperative order sets across all medical and surgical services, says Gregory A. Maynard, MD, chief of the division of hospital medicine. The protocol flags three levels of DVT risk, notes possible contraindications for a particular kind of patient, and presents a set of options for guideline-recommended prophylaxis. The protocol can be paper- or computer-based.

 

• The Johns Hopkins Hospital in Baltimore, also awarded as a representative for medical centers with more than 200 beds, developed a mandatory computer-based decision support system to facilitate specialty-specific risk factor assessment and the application of risk-appropriate VTE prophylaxis.

 

• The Washington, D.C., Veterans Affairs Medical Center won in the category representing medical centers with fewer than 200 beds. The hospital designed a seven-step process that walks providers through an evidence-based risk-factor assessment to determine appropriate thromboprophylactic therapy. 

The DVTeamCare Hospital Award reflects NATF's goal of enhancing thrombosis education, prevention, diagnosis, and treatment to improve patient outcomes, says NATF Executive Director Ilene Sussman, PhD.

Dr. Maynard and his UCSD colleagues have made their DVT prophylaxis toolkit available to other hospitalists wanting to lead similar efforts in their own hospital. The toolkit is posted both on the AHRQ and SHM Web sites.

"SHM and AHRQ should feel proud about this because we were one of the first places to do this successfully at such a high level," Dr. Maynard says. "We partnered with others and with SHM to build similar toolkits. SHM built VTE prevention collaboratives that enroll hospitalist leaders and mentor them through the process of VTE prevention performance improvement, tracking results longitudinally. Divya Shroff and her group in Washington, D.C., were enrolled in that VTE prevention collaborative. Their team won an award in VTE prevention by following the road map and by coming up with a good order set for DVT prevention that could be used in their VA hospital and in many other VAs across the country. I think that speaks to the strength of the concepts that we're using."

Each of the award-winning protocols will be presented at an NATF-sponsored program April 9 at Harvard Medical School in Boston. After the presentation, the winning protocols and implementation plans will be available at www.DVTeamCareAward.com to help other hospitals enhance their efforts to prevent DVT.