At Brigham & Women's, one important project several years ago used an electronic alert system that notifies providers when their patients were at risk of VTE, but weren't on appropriate prophylaxis.
"We devised a computer program that could look at a patient's chart online, pull out risk factors and generate a score, and if they fell into a certain risk category, an electronic alert would show up on the screen," Piazza says.
Over a 90-day study period, physicians not only raised the number of patients who received appropriate prophylaxis, but "also reduced symptomatic DVT and PE by over 41%" for as long as 90 days after patients left the hospital, an important measure since hospital-associated VTE risk factors are increased just after discharge.
But Piazza says there's still room for improvement in three major areas.
Just because there's an electronic alert doesn't mean physicians followed it, and in some cases providers didn't agree with the computer's assessment of the patient's risk. "Maybe the patient looked to the physician to be a lot better than the risk score implied."
Also, he says, in hospitals throughout the United States, often patients refuse doses of anticoagulants, perhaps because they were anxious about getting an injection. To deal with that, Brigham & Women's implemented a 500-patient study. "Pharmacists visited each patient and explained why they personally were at risk for VTE, and why they needed this anticoagulation medicine. We were able to increase the number of patients who got all their doses to 95%."
Another priority is trying to follow high- or moderately high-risk patients after they leave the hospital, who often end up back in the hospital with a "present on admission" VTE. "We know that because of pressure to discharge patients and shorter lengths of stay that some patients go home earlier, and while that's safe, they're recovering and not as mobile as they might be, and they're still at risk for VTE. But we don't know if or how long continued doses of anticoagulation medicines really provide protection."
That's an area that needs more work.
The nation's VTE experts, including those at the CDC, say that hospitals are only in the earliest stages of understanding how much VTE death and illness they can prevent with better stewardship in the care process, not just from admission, but to weeks or months after discharge.
Maynard says that the proof is evident when protocols are implemented. "When we did it, we got fewer VTE and no increase in bleeding or HIT. I fear the clot more than I fear the risk of bleeding from anticoagulants."
"Hospitals' chance of success, if they follow certain principles, is high," says Maynard. "It just needs leadership's support, for standardization and measurement, to follow the right road map."
This article appears in the November 2012 issue of HealthLeaders magazine.