Leading the Way in Patient Care and Quality Improvement
Blood clots that can develop in the limbs and travel to the lungs are considered the leading cause of preventable death in hospitalized patients. The Division of Hospital Medicine at UC San Diego Medical Center has received national recognition for a program that protects hospital patients from developing those blood clots. The medical center’s Venous Thromboembolism (VTE) Prevention Team was awarded the Society of Hospital Medicine's first ever Team Approaches in Quality Improvement Award at the Hospital Medicine 2008 meeting in San Diego in April.
In a three-year study, headed by Greg Maynard, M.D., Clinical Professor of Medicine and Chief of Hospital Medicine at UC San Diego Medical Center, the VTE Prevention Team set out to find the best ways to prevent hospital-acquired blood clots and build tool kits that enable others to do the same. The SHM announcement of the award noted that the UC San Diego multidisciplinary team approach “substantially reduced the number of preventable blot clots and saved lives and money.” Members of the UC San Diego team included Ian Jenkins, M.D., Sarah Stone, M.D., Josh Lee, M.D., Tim Morris, M.D., Peter Fedullo, M.D., Robert Schoenhaus, PharmD., Doug Humber, PharmD., Marian Renvall, Pat Cal, Ed Fink, and Isabella London.
“The patient benefits of this program go beyond our own UC San Diego patients,” said Maynard. “We’re using tools, largely developed at UC San Diego, to help guide other medical centers through the process. We’re mentoring other hospitalists to be leaders in hospital improvement in general, not only as pertains to VTE.”
During any hospital stay, a patient has a significant risk of developing a blood clot in a limb that may travel to the lung, a condition called hospital-acquired venous thromboembolism (VTE).
Nationwide, only about half the patients who stay in the hospital receive adequate blood clot prevention protection. That was also UC San Diego’s level of performance when the Division of Hospital Medicine started a “Partners in Patient Safety” project funded by the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services.
Now, just two years later, over 95 percent of UC San Diego Medical Center inpatients are receiving adequate clot prevention regimens and the number of UCSD patients who develop hospital-acquired clots has dropped by about 35 percent. That sets a new national benchmark.
“SHM recognizes that optimum health care is a team sport. The success of Maynard’s team at UC San Diego is a fine example of how hospitalists, along with the entire hospital-based care team, will be at the forefront of the next generation of health care delivery,” said Larry Wellikson, M.D., SHM’s chief executive officer. “Hospitalist leaders all over the country are leading teams of health professionals that are working hard to improve quality in our nation’s hospitals. SHM is proud to present Dr. Maynard and his team with our first-ever Team Approaches in Quality Improvement Award.”
Maynard and his coworkers developed a VTE prevention protocol, tested it, found it highly successful, and published it for other centers to use. Under the new protocol, every new or transferred patient is evaluated for his or her risk of developing a blood clot, and the appropriate measures are ordered. Nurses act as another line of defense, and can help identify patients who might otherwise have slipped between the cracks as their bleeding risk or clot risk changed.
The protocol, or tool kit, is now offered on the Society of Hospital Medicine (SHM) website, where it is the centerpiece of a SHM VTE Prevention Collaborative involving 30 medical centers from all over the country. As part of the Prevention Collaborative, Maynard is one of two mentors who work with hospitalists around the country. By telephone and email, he advises hospitalists who download and use the patient care protocols he has helped to develop.
“We identify the best practices and try to build them into a protocol on the front line of use so that every patient is exposed to that treatment practice. And we enable others beyond our local environment to do the same thing,” said Maynard.
Maynard has been a major figure in national efforts to improve the quality of inpatient care for many years. He is a leading member of the Society of Hospital Medicine, and has also worked nationally on inpatient management of diabetes and other common inpatient problems.
The UCSD Division of Hospital Medicine focuses on the special issues that affect the health and care of patients who are hospitalized at UCSD. Its mission is to provide excellent clinical care, educate residents and students, and to improve the quality and safety of inpatient care via team approaches to health systems redesign.
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