Your Resource for HQIC Highlights and Learning Opportunities | July 2021
Preventing Venous Thromboembolism (VTE)
Deep vein thrombosis (the formation of a blood clot in a deep vein) and pulmonary embolism (PE—a blood clot that travels to the lungs) are known collectively as venous thromboembolism, or VTE.

VTE is one of the most common forms of preventable death in hospitals. It is estimated that approximately 350,000–900,000 patients develop VTE each year in hospitals and approximately 100,000 patients who develop VTE die from it each year.1 It is the 5th most frequent reason for unplanned hospital readmissions after surgery, overall, and the 3rd most frequent among patients undergoing total hip or knee joint replacement. VTE is estimated to cost the U.S. healthcare system at least $7–$12 billion annually.2

Aside from the mortality risk, VTE is responsible for causing long-term chronic conditions. More than 20% of patients with proximal deep vein thrombosis (DVT) and/or PE will suffer a recurrent event once anticoagulation has been discontinued.3 Furthermore, 30%–50% of DVT patients will develop post-thrombotic syndrome, and an estimated 4% of PE patients will develop chronic thromboembolic pulmonary hypertension.4,5 Patients and their families relay powerful personal stories related to loss of function, difficulty with anticoagulant therapy, fiscal burden, and fear of recurrence.

VTE risk factors include multiple comorbidities, recent surgery, immobility or inadequate mobility, lack of individualized prophylaxis treatment, and lack of patient education and engagement in prevention. Even seemingly healthy patients who are admitted to the hospital for minor surgical procedures or routine childbirth find themselves at greater risk once hospitalized if progressive ambulation is not encouraged. This means that the vast majority of hospitalized patients are at some level of risk for developing VTE.6
The Flash: Resources
HSAG HQIC VTE Roadmap to Success
Use the VTE Roadmap to Success to prevent VTE events. The roadmap includes evidence-based tools, resources, and instructions for each step of your journey.

Prepare for the VTE journey:
  • Obtain leadership commitment, recruit a project champion, and charter a multidisciplinary team.
  • Engage patients and families.
  • Stratify VTE risk.
  • Standardize care processes.
  • Utilize clinical decision support.
  • Implement processes to prevent failure.
  • Identify and mitigate points of failure.
  • Use smart technology.
Final destination: Ensure your process is stable by monitoring process and outcome measures, implementing a control or sustainability plan, and handing off your process to a “process owner,” if needed.
HSAG HQIC Zone Tool: Stroke
This tool can be given to patients upon discharge to help them prevent and recognize signs of a stroke.

The Zone Tools were created to assist patients in managing their conditions after discharge. To view all the Zone Tools for a variety of conditions, available in English and Spanish, go to www.hsag.com/hqic-zone-tools.
VTE Risk Score Calculator
This online calculator predicts 3-month risk of VTE in hospitalized patients.
CDC*: VTE Training and Education for Healthcare Professionals 
This webpage includes definitions, statistics, articles, and training courses.
Janssen: Improving DVT/PE Transitions of Care
This guide by Janssen Pharmaceuticals can help ensure patients with DVT/PE properly transition from the hospital.
*CDC = Centers for Disease Control and Prevention
Upcoming Events and Education
Quality and Safety Series
The HSAG HQIC Quality and Safety Series is designed to assist your organization in its quality improvement journey, from planning and preparation to sustaining gains.

Offered on the 2nd and 4th Tuesdays of the month, this series is designed as a set of learning modules for the novice or a refresher of skills for the expert.

These "quick-inars" consist of a 30-minute or less, bite-size learning presentation to review key skills necessary to function in the quality improvement role or for other staff members participating in a quality improvement initiative.
Quality and Safety Series: 1. Team Forming
Tuesday, July 13, 2021
2–2:30 p.m. ET (11 a.m. PT | 12 noon MT | 1 p.m. CT)

Objectives:
  • Identify the key members of a team.
  • Review resources to keep your team organized.
  • Discuss the stages of team development
Quality and Safety Series: 2. Buy-In
Tuesday, July 27, 2021
2–2:30 p.m. ET (11 a.m. PT | 12 noon MT | 1 p.m. CT)

Objectives:
  • Define buy-in.
  • Discuss the importance of buy-in.
  • Identify methods for achieving buy-in.
Peer Groups
Peer groups are beginning to meet on a number of subjects. For further details on future peer group sessions, visit the HSAG HQIC online events calendar.
Sepsis Peer Group: Critical Access Hospitals
Session 1
Thursday, July 15, 2021
2–3 p.m. ET (11 a.m. PT | 12 noon MT | 1 p.m. CT)
This peer group is designed to create an all-teach, all-learn environment for critical access hospitals that are focusing on improving sepsis performance.
Sepsis Peer Group: Acute Care Hospitals
Session 1
Thursday, July 29, 2021
2–3 p.m. ET (11 a.m. PT | 12 noon MT | 1 p.m. CT)
This peer group is designed to create an all-teach, all-learn environment for acute care hospitals.
Other HSAG HQIC Educational Webinars
Falls TIPS Program
Tuesday, July 20, 2021
1–2 p.m. ET (10 a.m. PT | 11 a.m. MT | 12 noon CT)
This webinar will provide an overview of the Fall TIPS (Tailoring Interventions for Patient Safety) Program and its impact on falls reduction in acute care settings. The TIPS Program is a nurse-led, evidence-based fall prevention intervention that uses bedside tools to communicate patient-specific risk factors for falls and includes a tailored prevention plan.

Presenter
Patricia Dykes, PhD, MA, RN

One continuing education (CE) unit available.*
Using PRAPARE to Collect SDOH Data
Thursday, July 22, 2021
2–3 p.m. ET (11 a.m. PT | 12 noon MT | 1 p.m. CT)
HSAG HQIC offers an overview on how to use the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) assessment tool to collect and document data on the social determinants of health (SDOH).

Objectives
  • Discover how PRAPARE enables hospitals to better understand patient complexity, address social risks, and demonstrate value. 
  • Identify workflows, tips, and strategies for effectively implementing PRAPARE. 
  • Explore examples of how PRAPARE has led to changes at the patient, organization, and community level.

Presenters
Nalani Tarrant and Sarah Halpin, National Association of Community Health Centers (NACHC)

One CE unit available.*
*Continuing Education
Continuing Education (CE): Health Services Advisory Group, Inc., is the CE provider for this event. Provider approved by the California Board of Registered Nursing, Provider Number 16578, for 1 contact hour. There is no charge to attend this event. You must attend the live event to earn CE credit.
Critical Communication
HSAG HQIC Culture of Safety and the IHI National Action Plan to Advance Patient Safety Assessment
The Culture of Safety Assessment was developed by the Institute for Healthcare Improvement (IHI) to establish a baseline for the culture of safety infrastructure in your hospital. Implementing a culture of safety program can simultaneously reduce all-cause harm, incorporate Safety Across the Board and High Reliability, measure progress in overall safety, and identify potential correlations between a culture of safety and harm reduction.

The Culture of Safety Assessment contains 4 sections:
  1. Culture, leadership, and governance
  2. Patient and family engagement (PFE)
  3. Workforce safety
  4. Learning systems

HSAG HQIC is providing the Culture of Safety Assessment in an online format with the incorporation of the Centers for Medicare & Medicaid Services (CMS) PFE 5 focus measures. A short, how-to video on navigating the Culture of Safety Assessment is available at the button below. To access and complete the assessment, click the online assessment button and use the de-identified username provided to you by your Quality Advisor. 

Congratulations if you have completed your Culture of Safety Assessment! Look for communication from your Quality Advisor to review your results, see how you compare to others in the HSAG HQIC Program, and determine the level of support to meet your prioritized needs.
It Figures
The Secure Data Portal Is Live! Do You Know How to View Your Data?
Your Quality Advisor will reach out regarding dashboard orientation. Reminder: To view your data in the dashboard you should have completed the following:
 
  • Data Use Agreement: Review, sign, and return. This document provides permission for HSAG HQIC to access and use specified data to measure and track hospital performance, provide data feedback reports, and populate the HSAG HQIC Quality Improvement and Innovation Portal (QIIP) Secure Data Portal.
  • National Healthcare Safety Network (NHSN) Confer Rights: This document contains detailed instructions to join the HSAG HQIC group and give HSAG HQIC permission to view your hospital's healthcare-associated infection (HAI) data.
  • Web Portal Data Administrator Form: Complete and return. This form designates specific people in your organization to access the QIIP to view performance reports and dashboards, upload data, complete assessments, and manage users.
 
For questions or assistance with this process, please contact the HSAG HQIC team at hospitalquality@hsag.com.
1Rathbun, S. The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism. Circulation. April 2009; 119:e480-e482. Available at: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.108.841403
2Grosse S. et al. The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs. Elsevier. January 2016 Volume 137, Pages 3–10. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0049384815302097
3Prandoni P, Noventa F, Ghirarduzzi A, et al. The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica 2007 Feb;92(2):199-205. Available at: https://pubmed.ncbi.nlm.nih.gov/17296569/.
4Kahn SR. How I treat post-thrombotic syndrome. Blood 2009 Nov 19;114(21):4624-31. Available at: https://pubmed.ncbi.nlm.nih.gov/19741190/.
5Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004 May 27;350(22):2257-64. Available at: https://pubmed.ncbi.nlm.nih.gov/15163775/.
6Heit, J. et. al. Incidence of venous thromboembolism in hospitalized patients vs community residents. Elsevier. November 2001. https://doi.org/10.4065/76.11.1102. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0025619611625007
This material was prepared by Health Services Advisory Group (HSAG), a Hospital Quality Improvement Contractor (HQIC) under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this document do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication No. XS-HQIC-XT-06282021-01