降低住院患者静脉血栓栓塞症（VTE）发生率：在学术医疗中心，将继续教育与跨专业团队为基础的质量改进相结合。

Reduction of venous thromboembolism (VTE) in hospitalized patients: aligning continuing education with interprofessional team-based quality improvement in an academic medical center.

机构信息

Dr. Pingleton is Joy McCann Professor of Women in Medicine and Science and associate dean of continuing education and professional development, University of Kansas School of Medicine, Kansas City, Kansas. Ms. Carlton is director of quality, Department of Nursing, University of Kansas Hospital, Kansas City, Kansas. Ms. Wilkinson is assistant director of pharmacy inpatient services, University of Kansas Hospital, Kansas City, Kansas. Dr. Beasley is assistant professor of medicine, University of Kansas School of Medicine, Kansas City, Kansas. Dr. King is assistant professor of medicine, University of Kansas School of Medicine, Kansas City, Kansas. Ms. Wittkopp is director of quality outcomes, Organizational Improvement Office, University of Kansas Hospital, Kansas City, Kansas. Dr. Moncure is medical director of trauma and professor of surgery, University of Kansas School of Medicine, Kansas City, Kansas. Dr. Williamson is associate professor of pulmonary and critical care medicine, University of Kansas School of Medicine, Kansas City, Kansas.

出版信息

Acad Med. 2013 Oct;88(10):1454-9. doi: 10.1097/ACM.0b013e3182a4aa51.

DOI:10.1097/ACM.0b013e3182a4aa51

PMID:23969376

Abstract

PROBLEM

Despite clear prophylactic guidelines and national quality emphasis, a minority of hospitalized patients receive appropriate prophylaxis for venous thromboembolism (VTE). Data from the University of Kansas Hospital (KUH) revealed an unacceptably high incidence of VTE.

APPROACH

The authors aligned continuing education with quality improvement through formation of an interprofessional, multidisciplinary team to develop strategic educational and system operational plans to decrease VTE incidence. The authors reviewed 261 charts with the secondary diagnosis of VTE for identification of themes or causes of VTE to develop multipronged educational and system-based action plans. The authors reviewed a "menu" of evidence-based content delivery techniques to develop the educational plan. Multiple noneducational adjunct system strategies were also developed and implemented.

OUTCOMES

After implementation of all specific action plans, the KUH VTE incidence decreased 51% from November 2010 to June 2012 (from 12.68 to 6.10 per 1,000 patients). Insertion of peripherally inserted central catheters, a common identified theme, dropped from almost 360 insertions in December of 2010 to less than 200 insertions in April 2012.

NEXT STEPS

Aligning continuing education with quality improvement through an interprofessional, multidisciplinary team approach was associated with a decrease in VTE. The authors describe challenges and lessons learned to inform implementation of similar quality-improvement-driven continuing education initiatives elsewhere. Challenges included time, resources, multiple service lines, and departments with variable acceptance of data. Lessons learned included the value of leadership commitment, interprofessional team work, assessing individual data, expertise of continuing education, using multiple educational methods, and the need for overall champions.

摘要

问题

尽管有明确的预防指南和国家质量重点，但仍有少数住院患者接受了适当的静脉血栓栓塞症 (VTE) 预防措施。堪萨斯大学医院 (KUH) 的数据显示，VTE 的发生率高得令人无法接受。

方法

作者通过组建一个跨专业、多学科团队，将继续教育与质量改进相结合，制定了战略性的教育和系统操作计划，以降低 VTE 的发生率。作者回顾了 261 份有 VTE 次要诊断的病历，以确定 VTE 的主题或原因，制定多管齐下的教育和系统行动计划。作者回顾了一系列循证内容传递技术，制定了教育计划。还制定和实施了多种非教育附加系统策略。

结果

在实施所有具体行动计划后，KUH 的 VTE 发生率从 2010 年 11 月至 2012 年 6 月下降了 51%（从每 1000 名患者 12.68 例降至 6.10 例）。外周插入中心导管的插入，一个常见的确定主题，从 2010 年 12 月的近 360 次插入下降到 2012 年 4 月的不到 200 次插入。

下一步

通过跨专业、多学科团队方法将继续教育与质量改进相结合，与 VTE 的减少有关。作者描述了挑战和经验教训，以告知在其他地方实施类似的以质量改进为驱动的继续教育计划。挑战包括时间、资源、多个服务线和部门，以及对数据的不同接受程度。吸取的教训包括领导力承诺、跨专业团队合作、评估个人数据、继续教育专业知识、使用多种教育方法以及整体冠军的必要性的价值。