1. Advocate Good Samaritan Hospital DVT/PE Reduction Project Michael McKenna, MD VP, Medical Management

2. Opportunity

3. DVT/PE Trend – Medical Overall 64% medical vs 36% surgical

4. DVT/PE Trend – Surgical Overall 64% medical vs 36% surgical

5. Linkage to Strategic Plan: Quality, Physician Partnership, Service, and Finance Pillars Problem Statement: The DVT/PE complication rate presents an opportunity for improvement for Good Samaritan Hospital. The current DVT/PE complication rate per 1000 is 26.3. Benefits: Positive impact on patient outcomes (decreased morbidity, increased quality of life, decreased mortality, shorter hospital stay) and patient satisfaction (happy with the quality and service they received because they did not develop a complication of hospitalization). Scope: The team will implement a Performance Improvement methodology focusing on a data, measurement, and prompt and appropriate prophylaxis to reduce the DVT/PE complication rate for both medical and surgical patients. Process will be analyzed from admission to discharge. Goals: Specification Limit (minimum goal): complication rate of 23.7 pre 1000. Target: complication rate of 21.0 per 1000. Define Opportunity – Team Charter Sponsor: Dr. McKenna Project/Process Owner: Improvement Leaders: D.Calcagno, T.Esposito Milestones: DescriptionDate (mo/yr) #1 #2 #3 Milestones: DescriptionDate (mo/yr) #1 #2 #3 Key Metrics Medical DVT/PE complication rate Surgical DVT/PE complication rate Proper DVT prophylaxis utilization

6. Improving the Assessment Process Accountability moved to nursing – CareConnection Task/prompt Revamped assessment form – Risk assessment – Prophylaxis guidelines Standard Work – Procedure for completion and physician notification – Potential failure modes identified and addressed (e.g. shift change) – Audit process Pilot – Rapid cycle small test of change 43 completed assessments on pilot unit 65% of patients scoring high and highest categories

7. Initial Assessment Results 65% of patients scored High or Highest Risk Data Source: Care Connection- Patients Discharged 11/01/2007-01/31/2008

8. Sustained completion rate of 98% Assessment process also validated for accuracy and reliability Data Source: Care Connection- Patients Discharged 1/1/2008-9/30/2008 Assessment Results

9. Improve Prophylaxis VTE cases discharged between 8/2007 and 3/2008 were reviewed (n = 40) – DVT/PE was hospital acquired (not present on admission) – Demographic, administrative, and clinical data reviewed – 68% (n = 27) did not receive optimal pharmacological prophylaxis – Largest opportunity included circulatory cases 30% of all DVT/PE cases reviewed grouped into a circulatory MDC

10. DVT/PE Case Drilldown Circulatory cases – N size = 12 – 92% (n = 11) surgical cases – 83% (n = 10) did not receive optimal chemical prophylaxis

11. Next Steps Case by case review of VTE cases by physicians – Verification of optimal prophylaxis – Follow-up/feedback to individual physicians Leverage existing anticoagulation subcommittee for other DVT/PE reduction strategies