Stakeholders focused on cause and effect, updating policies, and in-depth review of fallouts. One service line changed its preoperative order set, including automatic assessment of VTE risk and orders for chemical prophylaxis. Our PSI-12 observed rate decreased from 9.94 in Q2-2021 to 1.2 in Q3-2022. Surgeon champions remain highly engaged. Keck Medicine of USC started the American College of Surgeons’ National Quality Improvement Program (ACS NSQIP) in 2021 to improve patient outcomes. NSQIP and Vizient data sets were utilized during the root cause analysis from 2021-2022, highlighting opportunities to enhance current VTE protocols. The persistence of VTE indicated a lack of compliance with prevention protocols. The NSQIP definition highlights venous thromboembolism (VTE) as a preventable condition affecting surgical patients both in hospital and post-discharge. The directional alignment between improvement opportunities for PSI-12 and the prevalence of VTEs in NSQIP data elevated the collaboration of physician partners within the Department of Surgery.
Problem: Lack of physician engagement in practice improvement with a goal of reducing postoperative VTE/PSI-12
Measurement: Line graphs were utilized to show trends in the frequency of occurrence quarterly. Bar graphs were used to determine the top causative factors contributing to VTE/PSI-12s as well as service lines with the highest occurrence rate
Analysis: We abstracted 1,565 cases for the calendar year 2021 with 1.92% resulting in VTE against the national benchmark of 0.98%. Twenty cases identified by Vizient as PSI-12 were compared with the NSQIP occurrences
Implementation: We created a working group meeting monthly, presenting NSQIP and Vizient data. During these meetings, stakeholders identified common themes and trends of VTE fallouts. This led to data being presented in larger committees, such as the quarterly Department of Surgery Quality Service Line meeting, enhancing collaboration among surgeons
