title: Preventing acute care-associated venous thromboembolism in adult and pediatric patients across a large healthcare system.
abstract: Although effective methods for venous thromboembolism prophylaxis (VTE-P) have been known for decades, reliable implementation has been challenging.
  
  
  
  Develop reliable VTE-P systems for adult and for pediatric patients to reduce preventable venous thromboembolism (VTE).
  
  
  
  We used a discovery and diffusion system to first develop an effective system in 1 hospital location, and then spread the principle best practices across the entire 22-hospital system.
  
  
  
  Twenty-two Mayo Clinic hospitals (adults and children).
  
  
  
  Adult and pediatric patients.
  
  
  
  (1) Ensure that a VTE-P is declared at admission by providing a mandatory VTE-P "tollgate" that requires the provider to assess the risk for VTE and provide an appropriate order for VTE-P. (2) Use clinical decision support to provide ongoing surveillance and alerts to providers when there is a lapse in the VTE-P plan.
  
  
  
  In adults, VTE compliance as measured by the Centers for Medicare and Medicaid Services Core Measures VTE-1 and VTE-2, preventable VTE as measured by VTE-6, and in pediatric patients, appropriate VTE measures as determined by chart audit.
  
  
  
  VTE-1 and VTE-2 have approached 97% to 100% and preventable VTE has declined to 0% for the last 3 quarters. Similarly, the pediatric VTE-P screening tool was evaluated and piloted with >92% compliance in risk documentation, appropriate VTE-P >64%, and 0 VTE events during the study period.
  
  
  
  An integrated system-wide approach can lead to measurable improvements in VTE-P process and outcome measures. Journal of Hospital Medicine 2016;11:S15-S21. © 2016 Society of Hospital Medicine.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
authors.affiliation: Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Vilmarie
authors.initials: V
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D058996:Quality Improvement; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000517:prevention & control
chemical_list: D000925:Anticoagulants