Data collection and measurement remain a central issue for most participants. Nearly every mentoring call (mentors and participants speak once a month for the first six months of enrollment and every three months thereafter) focused at least in part on figuring out how to develop baseline data, monitor adherence to a new protocol, and determine if clinical outcomes were improving.
Of note, 100% of respondents said they would recommend the collaborative to others.
Hospitalists and QI
An impressive 67% of respondents indicated their work on the VTE project has helped identify them as a QI leader in their hospital or within their hospital medicine group. More impressively, 93% are working on or have signed up to work on other QI efforts.
The range of topics participants are turning their attention to are amazingly varied: acute coronary syndromes, heart failure, sepsis, glycemic control, pneumonia, delirium prevention, therapeutic hypothermia, hand washing, core measures, Joint Commission certification for a number of diagnoses/processes, do-not-resuscitate documentation/ordering, medication reconciliation, SCIP, hand-off communications, and computerized physician order entry. Or, as one respondent put it, “too many projects to name.”
While it is heartening that success in one area is being leveraged in other areas, a sobering reality is that only 7% of these folks have allotted time to pursue QI projects – all others do QI work on a volunteer basis, in addition to existing clinical and administrative responsibilities.
QI work is fun and rewarding but also time-consuming and at times, difficult and lonely. Heroic volunteerism is not necessarily a bad thing—many hospitalists are passionate about improving care and contributing to the hospitals where they work. Too much volunteerism leads to burnout and ultimately is not sustainable. Perhaps a mentoring emphasis should be helping people recognize and quantify the value of their efforts, and developing the negotiation skills that would help secure funding for their work.
Drs. Maynard and Stein are among the SHM members with an interest in VTE who have convened the VTE Advisory Board. Under the leadership of Sylvia McKean, MD, the advisory board is exploring ways SHM can continue its work to promote the prevention, diagnosis and treatment of VTE.
Areas of interest include working with health systems, as opposed to individual hospitals, as a means of rapidly spreading tools and processes that promote assessment of VTE risk and administration of appropriate prophylaxis. The VTE collaborative team was thrilled to welcome five Veterans Affairs (VA) hospitals into the collaborative. It is hoped this group will succeed not only in developing successful local VTE prevention efforts, but also will develop a framework and set of tools that can be exported to all VA sites. Leveraging commonly used health IT systems is another exciting option for rapidly disseminating the tools and materials the collaborative’s members have developed.