title: Reduction in Venous Thromboembolism Events: Trauma Performance Improvement and Loop Closure Through Participation in a State-Wide Quality Collaborative.
abstract: BACKGROUND
  The Michigan Trauma Quality Improvement Program (MTQIP) is a collaborative quality initiative sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network (BCBSM/BCN). The MTQIP benchmark reports identified our trauma center as a high outlier for venous thromboembolism (VTE) episodes. This study outlines the performance improvement (PI) process used to reduce the rate of VTE using MTQIP infrastructure.
  
  
  METHODS
  Trauma patients admitted for > 24 hours, with an Injury Severity Score (ISS) ≥ 5, were included in this study. We performed a preliminary analysis examining prophylaxis drug type to VTE, adjusted by patient confounders and timing of first dose, using MTQIP data abstracted for our hospital. It showed that patients receiving enoxaparin had a VTE rate that was half that of those receiving unfractionated heparin (odds ratio 0.46, 95% CI 0.25 to 0.85). Guided by these results, we produced the following plan: consolidation to single VTE prophylaxis agent and dose, focused education of providers, initiation of VTE prophylaxis for all patients-with clear exception rules-and dose withholding minimization. Results were monitored using the MTQIP platform.
  
  
  RESULTS
  After implementation of our focused PI plan, the VTE rate decreased from 6.2% (n = 36/year) to 2.6% (n = 14/year). Our trauma center returned to average performance status within MTQIP.
  
  
  CONCLUSIONS
  Participation in MTQIP provided identification of trauma center outlier status for the outcome of VTE. Analysis of MTQIP data allowed creation of a local action plan. The MTQIP infrastructure supported execution and monitoring of the action plan consistent with loop-closure practices, as advocated by the American College of Surgeons Committee on Trauma, and a positive performance improvement result was achieved with VTE reduction.
authors.affiliation: Division of Acute-Care Surgery, University of Michigan, Ann Arbor, MI. Electronic address: dmachad@med.umich.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Machado-Aranda
authors.affiliation: Division of Acute-Care Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Jill L
authors.initials: JL
authors.lastname: Jakubus
authors.affiliation: Department of Surgery, St Joseph Mercy Health System, Ann Arbor, MI.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Wahl
authors.affiliation: Division of Acute-Care Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Jill R
authors.initials: JR
authors.lastname: Cherry-Bukowiec
authors.affiliation: Division of Acute-Care Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: To
authors.affiliation: Division of Acute-Care Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Pauline K
authors.initials: PK
authors.lastname: Park
authors.affiliation: Division of Acute-Care Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Krishnan
authors.initials: K
authors.lastname: Raghavendran
authors.affiliation: Division of Acute-Care Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Lena M
authors.initials: LM
authors.lastname: Napolitano
authors.affiliation: Division of Acute-Care Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Hemmila
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D002985:Clinical Protocols / Q000592:standards*; D017984:Enoxaparin / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015601:Injury Severity Score; D008824:Michigan / Q000453:epidemiology; D058996:Quality Improvement; D014193:Trauma Centers / Q000592:standards*; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000453:epidemiology*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin