Surgical Care Improvement Project Prevention of Post-operative Venous Thromboembolism Team Membership Department of Surgery, Nursing, General Medicine, Pharmacy, CCE

Opportunity Statement Venous thromboembolism (VTE- deep vein thrombosis and pulmonary embolism) is the most common preventable cause of death following surgery. The rate of post-operative VTE at LUMC (2-3%) is at the 90 th percentile compared to other Academic Medical Centers (UHC data)

Rate per 100 cases Post-operative pulmonary embolism or deep vein thrombosis Quarter LUHS Rate UHC Ninetieth Percentile UHC Median UHC Tenth Percentile 2002 Q12002 Q22002 Q32002 Q42003 Q12003 Q22003 Q32003 Q42004 Q12004 Q22004 Q32004 Q42005 Q12005 Q22005 Q

Project Goals Achieve a 50% reduction in the occurrence rate of post-operative venous thromboembolism

Most Likely Causes for Current Opportunity Surgical patients are not routinely assessed and stratified for VTE risk Wide variability in use of prophylactic methods Variable awareness of national, evidence-based guidelines* Under utilization of pharmacologic prophylaxis (heparin) * Geerts, WH et al. Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:338s-400s.

Solutions Planned Developed Risk Assessment Tool (see figure 1) Developed guideline for selection of appropriate VTE prophylaxis for surgical patients (see figure 1) Contacted Best Practice Academic Medical Centers

Next Steps Pilot Risk Assessment Tool and Guideline in Department of Surgery Monitor use of risk assessment tool Evaluate the use of mechanical and pharmacologic based upon risk stratification and prophylaxis guidelines Implement Risk Assessment Tool and Prophylaxis Guideline in Orthopaedic Surgery and Neurosurgery Continue comparison with UHC data