TY - JOUR
T1 - Multi-institution evaluation of adherence to comprehensive postoperative VTE chemoprophylaxis
AU - Yang, Anthony D.
AU - Hewitt, Daniel Brock
AU - Blay, Eddie
AU - Kreutzer, Lindsey J.
AU - Quinn, Christopher M.
AU - Cradock, Kimberly A.
AU - Prachand, Vivek
AU - Bilimoria, Karl Y.
N1 - Funding Information:
From the *Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago, IL; †Department of Surgery, Thomas Jefferson University Hospital, Phila-delphia, PA; zDepartment of Surgery, Temple University Hospital, Philadel-phia, PA; §Department of Surgery, Carle Foundation Hospital, Urbana, IL; and ôDepartment of Surgery, University of Chicago School of Medicine, Chicago, IL. Sources of Funding: American College of Surgeons (Thomas R. Russell Faculty Research Fellowship [ADY]), National Institutes of Health (5T32HS000078 [DBH], 5T32HL094293 [EB] and R01HS024516 [KYB]), Health Care Ser-vices Corporation/Blue Cross Blue Shield of Illinois. Presented at the 13th Annual Academic Surgical Congress Clinical Outcomes Plenary Session, February 1, 2018, Jacksonville, FL. ADY and DBH contributed equally to this work. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.annalsofsurgery.com). Reprints: Anthony D. Yang, MD, MS, Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St. Clair Street, 20th Floor, Chicago, IL 60611. E-mail: ayang@isqic.org. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0003-4932/19/27106-1072 DOI: 10.1097/SLA.0000000000003124
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Objectives:The aims of this study were to: (1) measure the rate of failure to provide defect-free postoperative venous thromboembolism (VTE) chemoprophylaxis, (2) identify reasons for failure to provide defect-free VTE chemoprophylaxis, and (3) examine patient- and hospital-level factors associated with failure.Summary Background Data:Current VTE quality measures are inadequate. VTE outcome measures are invalidated for interhospital comparison by surveillance bias. VTE process measures (e.g., SCIP-VTE-2) do not comprehensively capture failures throughout patients' entire hospitalization.Methods:We examined adherence to a novel VTE chemoprophylaxis process measure in patients who underwent colectomies over 18 months at 36 hospitals in a statewide surgical collaborative. This measure assessed comprehensive VTE chemoprophylaxis during each patient's entire hospitalization, including reasons why chemoprophylaxis was not given. Associations of patient and hospital characteristics with measure failure were examined.Results:The SCIP-VTE-2 hospital-level quality measure identified failures of VTE chemoprophylaxis in 0% to 3% of patients. Conversely, the novel measure unmasked failure to provide defect-free chemoprophylaxis in 18% (736/4086) of colectomies. Reasons for failure included medication not ordered (30.4%), patient refusal (30.3%), incorrect dosage/frequency (8.2%), and patient off-unit (3.4%). Patients were less likely to fail the chemoprophylaxis process measure if treated at nonsafety net hospitals (OR 0.62, 95% CI 0.39-0.99, P = 0.045) or Magnet designated hospitals (OR 0.45, 95% CI 0.29-0.71, P = 0.001).Conclusions:In contrast to SCIP-VTE-2, our novel quality measure unmasked VTE chemoprophylaxis failures in 18% of colectomies. Most failures were due to patient refusals or ordering errors. Hospitals should focus improvement efforts on ensuring patients receive VTE prophylaxis throughout their entire hospitalization.
AB - Objectives:The aims of this study were to: (1) measure the rate of failure to provide defect-free postoperative venous thromboembolism (VTE) chemoprophylaxis, (2) identify reasons for failure to provide defect-free VTE chemoprophylaxis, and (3) examine patient- and hospital-level factors associated with failure.Summary Background Data:Current VTE quality measures are inadequate. VTE outcome measures are invalidated for interhospital comparison by surveillance bias. VTE process measures (e.g., SCIP-VTE-2) do not comprehensively capture failures throughout patients' entire hospitalization.Methods:We examined adherence to a novel VTE chemoprophylaxis process measure in patients who underwent colectomies over 18 months at 36 hospitals in a statewide surgical collaborative. This measure assessed comprehensive VTE chemoprophylaxis during each patient's entire hospitalization, including reasons why chemoprophylaxis was not given. Associations of patient and hospital characteristics with measure failure were examined.Results:The SCIP-VTE-2 hospital-level quality measure identified failures of VTE chemoprophylaxis in 0% to 3% of patients. Conversely, the novel measure unmasked failure to provide defect-free chemoprophylaxis in 18% (736/4086) of colectomies. Reasons for failure included medication not ordered (30.4%), patient refusal (30.3%), incorrect dosage/frequency (8.2%), and patient off-unit (3.4%). Patients were less likely to fail the chemoprophylaxis process measure if treated at nonsafety net hospitals (OR 0.62, 95% CI 0.39-0.99, P = 0.045) or Magnet designated hospitals (OR 0.45, 95% CI 0.29-0.71, P = 0.001).Conclusions:In contrast to SCIP-VTE-2, our novel quality measure unmasked VTE chemoprophylaxis failures in 18% of colectomies. Most failures were due to patient refusals or ordering errors. Hospitals should focus improvement efforts on ensuring patients receive VTE prophylaxis throughout their entire hospitalization.
KW - Magnet
KW - SCIP-VTE-2
KW - chemoprophylaxis
KW - deep vein thrombosis
KW - pulmonary embolism
KW - quality
KW - safety net
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85084695756&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85084695756&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000003124
DO - 10.1097/SLA.0000000000003124
M3 - Article
C2 - 30632990
AN - SCOPUS:85084695756
SN - 0003-4932
VL - 271
SP - 1072
EP - 1079
JO - Annals of Surgery
JF - Annals of Surgery
IS - 6
ER -