Implementing Venous Thromboembolism (VTE) Screening & Bundle Elements for Prevention of Hospital-Acquired Conditions (HAC) at Texas Children’s Hospital (TCH)

Our pediatric institution participates in a national collaborative program to reduce hospital-acquired conditions (HACs). The major goal of this collaborative is to decrease or prevent serious harm related to events that can occur during a patient’s hospital stay. Data from this national organization shows that venous thromboembolism (VTE) is the second greatest contributor of harm throughout pediatric participating organizations. As a participating member of this organization, there were two major components for participation. The first was to identify current rates of this condition and provide accurate reporting. The second, based on their standard evaluation, was to consistently screen patients ≥ 12 years of age and provide the bundle elements of ambulation and sequential compression devices (SCDs). After an initial unsuccessful attempt at instituting this program, a multidisciplinary team was brought together in 2016 to formulate concepts toward establishment of an automated process to capture positive incidence of VTE, as well as a method to prompt staff to screen and provide associated bundle elements. This abstract centers on the implementation of an electronic VTE screening and bundle process. The factors, based on evidence-based criteria, if present during a patient admission, could contribute to the development of a VTE. The resulting score categorized the patient as low-, at-, or high-risk. Once a risk is determined, the standard bundle of ambulation and/or use of SCDs, if not contraindicated, was provided. Improvement assessed at adherence to VTE screen and bundle elements from 0% to 85%.

Methodology and analysis: The framework used to establish this program was based on the plan, do, study, act (PDSA) cycle. A set of four PDSA cycles to date were utilized to identify the best methods by which this process could be successfully put forth. In the first PDSA cycle, a single department was identified and provided a paper VTE screening tool for staff to identify eligible candidates for bundle utilization. In the second PDSA cycle, the screen was converted into an electronic tool within the EMR and training was developed and provided to the entire institution on usage. At this time, an electronic database was used to aggregate data on compliance of screen and bundle usage. In the third PDSA, gaps in consistent screening and bundle compliance were identified by creation of a VTE champion program with cooperation of a cardiac specialty group. A pre-intervention and post-intervention process based on feedback was added. Champions provided feedback to staff in email and discussion regarding the VTE initiatives. At this time, data was provided to this singular group in graphical format to emphasize the improvement process. Lastly, in PDSA four, the cardiac VTE champions expanded their program to all areas of the hospital with education and videos, utilizing the pre- and post-intervention method. Also, electronic triggers were created with the EHR specialist to aid staff in evaluating patients consistently in order to provide appropriate bundles.

Results: With the interventions put in place during PDSA three, there was an increase in compliance with VTE screen and bundle compliance from 50% to 74%.