Hospital Improvement Efforts Target Blood Clots

Much of the reporting I’ve seen so far about improving processes has health care has focused either on eliminating time wasted – i.e., improving patient flow – or on reducing or eliminating medical errors and problems, such as incorrect medications, incorrect surgery, infections, and so on.

recent story in the Philadelphia Inquirer falls into the second category, but it focuses on a problem I hadn’t seen mentioned in previous stories: blood clots.

In 2006, more than 2,000 surgery patients at hospitals in Philadelphia and its Pennsylvania suburbs developed blood clots. That was 14 cases for every 1,000 of those patients, according to an Inquirer analysis of billing records. A decade earlier, the rate was 9 cases per 1,000 surgical patients…

Chester County Hospital is trying to reduce that risk. Last year, it was one of 13 hospitals that participated in a regional effort to lower the incidence of postsurgical venous thromboembolism (VTE) - blood clots that obstruct flow in vessels of either a leg (deep vein thrombosis) or a lung (pulmonary emboli).

The hospitals were part of a broader quality-improvement campaign by the Partnership for Patient Care, a collaborative of local health-care institutions that also worked to reduce patients' falls in the hospitals and confusion when their prescriptions change.

Every year, local hospitals take on one or more of the partnership's initiatives. The choices for 2008: eliminating wrong-site surgery, standardizing the reporting of falls, and preventing bed sores. The collaborative helps hospitals identify and implement so-called best practices - those known to improve patient outcomes…

All the hospital systems in Southeastern Pennsylvania took part in at least one of last year's quality-improvement initiatives, and detailed surveys conducted at the start and end of the six-month programs suggest increased use of the best practices.

A true measure of success - actual data on, say, how many patients develop blood clots after surgery - isn't yet available.

Meanwhile, the day-to-day challenge is making sure that the correct actions are taken with every patient before, during and after surgery.

One example of best practices related to blood clots is to make sure that every surgery patient (or at least those having leg, knee or hip surgery) wears a so-called “compression stocking,” which prevents blood from accumulating in the leg. The relevant lean concept is standard work – making sure something is done exactly the same way every time.

It’s good to know more hospitals are moving in the right direction.

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