Implementing Sustainable Systems for Achieving Excellence in Venous Thromboembolism Prevention

Implementing Sustainable Systems for Achieving Excellence in Venous Thromboembolism Prevention

Oluwafemi P. Owodunni, MD, MPH

[email protected]

Elliott R. Haut, MD, PhD, FACS

[email protected]

Department of Emergency Medicine, The University of New Mexico Hospital, Albuquerque, NM (OPO)

Division of Acute Care Surgery, Department of Surgery (ERH)

Department of Anesthesiology and Critical Care Medicine (ERH)

Department of Emergency Medicine (ERH)

The Johns Hopkins University School of Medicine, Baltimore, Maryland

The Armstrong Institute for Patient Safety and Quality (ERH)

Johns Hopkins Medicine, Baltimore, Maryland

Department of Health Policy and Management (ERH)

The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Corresponding author:

Elliott R. Haut, MD, PhD, FACS

Vice Chair of Quality, Safety & Service, Department of Surgery

Professor of Surgery, Anesthesiology / Critical Care Medicine (ACCM) and Emergency Medicine

Division of Acute Care Surgery, Department of Surgery

The Johns Hopkins University School of Medicine

Professor of Health Policy & Management

The Johns Hopkins University Bloomberg School of Public Health

Core Faculty, The Armstrong Institute for Patient Safety and Quality, JHM

Sheikh Zayed 6107C

1800 Orleans St.

Baltimore, MD 21287

[email protected] (email)

@elliotthaut (Twitter)

Haut (https://orcid.org/0000-0001-7075-771X) 

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Abstract

Venous thromboembolism (VTE) is a common preventable cause of morbidity and mortality in hospitalized patients. Despite robust guidelines and decades of data, there is still underperformance in three important aspects of defect‑free VTE prevention.  The objectives of this perspective are threefold: first, to delineate the critical steps of risk-appropriate VTE prevention i.e., 1) risk assessment (balancing risks of VTE and bleeding), 2) prescription of risk‑appropriate prophylaxis, and 3) reliable administration of all prescribed VTE prophylaxis doses. Second, to examine why existing systems fail to deliver consistent risk-appropriate care; and third, to propose a pragmatic and scalable accountability framework to close these gaps. Drawing from evidence and implementation science, we propose a system-wide strategy that integrates electronic clinical decision support, individualized clinician feedback, and targeted nurse-specific and patient-centered education to reduce missed doses. Sustained success will require institutions to integrate the evidence-based processes within system-level infrastructure, with ongoing surveillance and quality improvement.

Key words: Deep Vein Thrombosis, Pulmonary Embolism, Venous Thromboembolism, Quality Improvement, Patient Safety, Thromboprophylaxis

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