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Mentored implementation: building leaders and achieving results through a collaborative improvement model. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med Mar 10; 10 Improved use of thromboprophylaxis for deep vein thrombosis following an educational intervention.

J Hosp Med Nov;1 6 Innovative approaches to increase deep vein thrombosis prophylaxis rate resulting in a decrease in hospital-acquired deep vein thrombosis at a tertiary-care teaching hospital. J Hosp Med ;3 2 Medical admission order sets to improve deep vein thrombosis prophylaxis rates and other outcomes.


J Hosp Med ;4 2 Maynard G. Medical admission order sets to improve deep vein thrombosis prevention: a model for others or a prescription for mediocrity? A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals. Ann Surg ; No magic bullets: a systematic review of trials of interventions to improve professional practice. CMAJ ; Compliance with recommended prophylaxis for venous thromboembolism: improving the use and rate of uptake of clinical practice guidelines.

Computerized order entry sets and intensive education improve the rate of prophylaxis for deep vein thrombophlebitis. Effect of a clinical pharmacy education program on improvement in the quantity and quality of venous thromboembolism prophylaxis for medically ill patients. J Manag Care Pharm ; Audit guided action can improve the compliance with thromboembolic prophylaxis prescribing to hospitalized, acutely ill older adults.

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The effect of a computerized reminder system on the prevention of postoperative venous thromboembolism. Chest ; A clinical decision support system for prevention of venous thromboembolism. JAMA ; A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med ; BMJ ;Jun 19;e Gawande, A. The checklist manifesto: how to get things right. Electronic alerts for hospitalized high-VTE risk patients not receiving prophylaxis: a cohort study. J Thromb Thrombolysis ; Physician alerts to prevent symptomatic venous thromboembolism in hospitalized patients.

Circulation ; University HealthSystem Consortium. Arya R, Hunt B, eds. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism Review. Cochrane Database of Systematic Reviews , Issue 7. Venous thromboembolism prophylaxis in hospitalized medical patients and those with stroke: a background review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med ;Nov 1; 9 The improvement guide. San Francisco: Jossey-Bass; Kilo CM.

A framework for collaborative improvement: lessons from the Institute for Healthcare Improvement's Breakthrough Series. Qual Manage Health Care ;6 4 Physicians as leaders in improving healthcare: a new series in Annals of Internal Medicine. Ann Intern Med ; A systematic narrative review of quality improvement models in healthcare. Institute for Healthcare Improvement. Innovation Series Going lean in healthcare. Basics of quality improvement in healthcare.


Mayo Clin Proc ;82 6 Agency for Healthcare Research and Quality. Accessed September 29, Translating evidence into practice: a model for large scale knowledge translation. BMJ ; Improved inpatient use of basal insulin, reduced hypoglycemia, and improved glycemic control: effect of structured subcutaneous insulin orders and an insulin management algorithm. J Hosp Med Jan;4 1 Indication based ordering: a new paradigm for glycemic control in hospitalized inpatients.

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J Diabetes Science Tech ;2 3 Maintaining glycemic control when transitioning from infusion insulin: a protocol-driven, multidisciplinary approach. J Hosp Med 8 Optimizing inpatient anticoagulation: strategies for quality improvement. In: Fang MC, ed.

Should we use prognostic scores for acute pulmonary thromboembolism in clinical practice?

Inpatient Anticoagulation. Multidisciplinary initiative to improve inpatient anticoagulation and management of venous thromboembolism. Am J Hosp Pharm ;71 4 Philadelphia: Society of Hospital Medicine; Mentored Implementation: building leaders and achieving results through a collaborative improvement model. J Hosp Med ;8 8 BMJ ;e Ann Surg ; 3 Venous thromboembolism prevention: a systematic review of methods to improve prophylaxis and decrease events in the hospitalized patient.

Hosp Pract ;38 1 Michota F. Bridging the gap between evidence and practice in venous thromboembolism prophylaxis: the quality improvement process. J Gen Intern Med ;22 12 Dobesh PP. Economic burden of venous thromboembolism in hospitalized patients. Pharmacotherapy ;29 8 Chapter 2 Maynard G, Stein J. Designing and implementing effective vte prevention protocols: lessons from collaboratives.

Chest ;Feb; 2 suppl :7SS. Chest 2 suppl :eS-eS. Chest Feb; 2 suppl :eS-eS. VTE, thrombophilia, antithrombotic therapy and pregnancy: antithrombotic therapy and prevention of thrombosis, 9 th ed. Chest Jun; 6 suppl SS. Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. Evidence-based guideline and evidence report from the American Academy of Orthopaedic Surgeons. Committee on Practice Bulletins—Obstetrician-Gynecologists.

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  5. Thromboembolism in pregnancy. Practice Bulletin ; 3 Reducing the risk of venous thromboembolism deep vein thrombosis and pulmonary embolism in patients admitted to hospital. Accessed April 18, Accessed March 4, Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines: antithrombotic therapy and prevention of thrombosis, 9 th ed: Chest Feb; 2 suppl SS.

    Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention PEP trial. Lancet ; Venous thromboembolism prevention guidelines for medical inpatients: mind the implementation gap. J Hosp Med ,8 10 Risk-assessment models for predicting venous thromboembolism among hospitalized non-surgical patients: a systematic review.

    Thrombosis and Embolism: from Research to Clinical Practice

    Laporte S, Mismetti P. Epidemiology of thrombotic risk factors: the difficulty in using clinical trials to develop a risk assessment model. The use of weighted and scored risk assessment models for venous thromboembolism. Thromb Haemost ; 6 Chest ; 3 Michota FA.

    signbascompdy.tk JGIM ;22 12 Crowther MA. Medical prophylaxis: the value of an "opt in" policy. Chest Feb; 2 suppl :7SS. Preventing hospital-acquired venous-thromboembolism: a guide for effective quality improvement.

    Deep Vein Thrombosis & Pulmonary Embolism Video – Brigham and Women’s Hospital

    High rates of venous thromboembolism prophylaxis did not increase the incidence of heparin-induced thrombocytopenia. A simple reminder system improves venous thromboembolism prophylaxis rates and reduces thrombotic events for hospitalized patients. Prevention of venous thromboembolism: best practice guidelines for Australia and New Zealand. Medication chart intervention improves inpatient thromboembolism prophylaxis. Improving the use of venous thromboembolism prophylaxis in an Australian teaching hospital. Venous thromboembolism is a common condition affecting 7. Incidence rates for venous thromboembolism are higher in men, African-Americans, and increase substantially with age.

    It is critical to treat deep venous thrombosis at an early stage to avoid development of further complications, such as pulmonary embolism or recurrent deep venous thrombosis. The target audience for this guideline is all clinicians caring for patients who have been given a diagnosis of deep venous thrombosis or pulmonary embolism. The target patient population is patients receiving a diagnosis of pulmonary embolism or lower-extremity deep venous thrombosis. Low-molecular-weight heparin LMWH rather than unfractionated heparin should be used whenever possible for the initial inpatient treatment of deep venous thrombosis DVT.

    Either unfractionated heparin or LMWH is appropriate for the initial treatment of pulmonary embolism. Consistent evidence demonstrates that LMWH is superior to unfractionated heparin for the initial treatment of DVT, particularly for reducing mortality and reducing the risk for major bleeding during initial therapy. Additional trials are needed to more rigorously examine the efficacy of LMWH for the initial treatment of pulmonary embolism, but systematic reviews of existing trials indicate that LMWH is at least as effective as unfractionated heparin for these patients as well.

    In addition, trials of unfractionated heparin in pulmonary embolism show that many patients are subtherapeutic or supratherapeutic while receiving unfractionated heparin whereas LMWH is quickly and consistently therapeutic, an important consideration in the treatment of VTE.

    Outpatient treatment of DVT, and possibly pulmonary embolism, with LMWH is safe and cost-effective for carefully selected patients, and should be considered if the required support services are in place. In trials that compared inpatient and outpatient treatment, the rates of recurrent DVT, major bleeding, and death during follow-up differed only slightly. These studies were conducted among highly selected groups of patients and in clinical systems with the required support services in place.

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    8. Several studies allowed a brief inpatient admission for stabilization of the patients before randomization to the outpatient group. While some studies enrolled patients with concomitant pulmonary embolism, the majority excluded such patients. Inclusion criteria were strict; most studies excluded patients with previous VTE, thrombophilic conditions, significant comorbid illnesses, pregnant patients, and those unlikely to adhere to outpatient therapy.

      Therefore, this recommendation cannot be generalized. Compression stockings should be used routinely to prevent postthrombotic syndrome, beginning within 1 month of diagnosis of proximal DVT and continuing for a minimum of 1 year after diagnosis.