Virtua Health

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Virtua Health

• Sharon Mindel, Pharm D
• Terry Rodgers, RN, MSN
• Jeannie Ritzius, RN

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TIME IS RUNNING OUT
ST P THE CLOT!
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Virtua Health

• Four hospital system in Southern New Jersey
• Two Long Term Care Facilities
• Two Home Health Agencies
• Two Free Standing Surgical Centers (JVs)
• Two Medical Staffs (currently merging)
• Ambulatory Care - Camden
• Fitness Center
• 7,100 employees 2000 physicians
• 7,752 deliveries
• 8 Operating Margin - 1 in the state of NJ
• STAR Culture

Virtua receives the JCAHO Gold Seal forStroke
Center at Memorial,Total Joint Program,and
Spine Program
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DVT PE VTE

• 200,000 600,00 reports of VTE in the United
  States annually contribute to 60,000 200,000
  deaths per year
• More deaths than AIDS, breast cancer and highway
  
• fatalities combined
• VTE is preventable
• Many patients at risk do not receive prophylaxis

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Risk of VTE in Hospitalized Patients
Patient Group VTE Prevalence,
Medical Patients 50-70 General Surgery 15-40 Stroke 20-50 Hip/Knee Arthroplasty, Fracture 40-80 Major Trauma 50-80 Spinal Cord Injury 60-100 Critical Care Patients 10-33
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Project Title Standard Practice for Venous
Thromboembolism (VTE) Prophylaxis Division (s)
Marlton
Goal/Opportunity/ Description Statement To
increase clinical quality and patient safety and
decrease cost associated with VTE Target 90 of
patients identified at risk for VTE will be
prophylaxed
Sponsor (s) Carol Mullin Process Owner (s) Mary
Ann Krug, Sharon Mindel, Terry Rodgers, Dee Page,
Sabina Zabrodski, Lynn Block Team Members
Sharon Iannece, Mary Saunders, Jennifer
Smith Green Belt Terry Rodgers Master Black
Belt Donna Forrest Black Belt Jeannie
Ritzius Physician Advisor Dr. Sutherland
?
?
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Measure Phase
What is the Right Y to Measure? How will it be
measured? Prophylaxis of patients assessed for
risk of VTE. Discrete data was used to be
measured through chart review of discharged
patients.
What is a Defect? What are the process
specifications? Y1 Defect Not prophylaxing
patients identified at risk for VTE USL none
LSL none Target 90 based on Sponsor
identified CTQ
Measurement System Accuracy An SOP was developed
20 charts were gaged Initial gage revealed 90
agreement Repeat gage after review of SOP
revealed 95 correct and agreed upon 20 charts
were gaged using hard copy Medical Records This
gage also had 95 confidence
Data Sources Medical Records and Net Access 249
Charts manually and electronically
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Measure Phase Metrics
Initial Z Score for 249 Patients
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Pareto Charts for Medical Surgical Patients
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VTE Assessment / Prophylaxis Order Form
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Pre - and Post - Pilot Performance
Initial Z score for Surgical Patients 8.8 Defects
Initial Z score for Medical Patients 57.1 Defects
11.9 Defects from pilot data for Medical Patients
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Chi Square Test Results From Pilot

• A P-value of
• lt .05 shows a
• statistically
• significant
• difference

Chi Square Test Passed-Failed
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Project Performance
Project Y Data Type Test Initial Performance Current Performance Statistical Significance
Not prophylaxing patients identified at risk for VTE Discrete Z- Calc Chi - Square Z 0 Z 2.68 P- value lt .05
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Accomplishments

• Gage completed with 95 confidence
• Shared learning with Physicians from Deborah
  hospital
• Piloted electronic chart reviews
• Pilot program completed with three Physician
  groups
• Presentations throughout Virtua
• PT
  VTE Education with CEUs
• Forms Committee Development of TRIP sheet
• Medical Exec for each division
  Virtua Vine Intranet Education
• Quality and Risk Committee Guess
  the Calf Contest
• Quality News letter
  NEC MPNEC
• Surgical Council
  Pharmacy Directors
• Vendor Expo participation
  Unit Based Council Education
• All day poster presentations on each campus
• Individual presentation to physicians / physician
  groups
• Unit Secretary education

Dr. Chelemer and Dr. Sutherland worked together
with the VTE team to develop the final form for
VTE prophylaxis, and presented the form to key
committees and departments.
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Change Acceleration Process
Leading Change
Creating A Shared Need
Shaping A Vision
Mobilizing Commitment
Current State
Transition State
Improved State
Making Change Last
Monitoring Progress
Changing Systems Structures
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Formula for Change
Q x A E Quality X Acceptance
Effectiveness
many quality efforts fail due to lack of
attention to the cultural and people side of
change -- the A
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Performance after Project implementation to all
campuses
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Future VTE Measures

• VTE prophylaxis addressed in surgical patients
  with SCIP
• Joint Commission/NQF Project currently testing
  measures
• NQF VTE Steering Committee will recommend
  specific measures
• Anticipate 2008 NQF will endorse measures
• No specific plans for implementation

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Lessons Learned

• System wide focus
• Focus on broad range of VOC when dealing with
  multiple medical staffs
• Over-communicate
• More CAP with physicians Q X A SUCCESS
• CORE measures can often drive physician
  compliance
• Six Sigma is effective for clinical settings
• Development of EMR will improve compliance

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Cap O Gram
C 4/17/07
How likely is this project to be successful ?
100
90
88
95
C 8/16/06
96
80
90
93
95
95
88
88
92
95
90
80
80
75
90
75
80
80
70
75
80
75
70
75
75
I 3/17/06
70
70
70
60
65
60
55
A 4/1/06
50
50
50
45
45
45
M 3/1/05
35
25
25
D 1/1/05
0
Leading Change
Creating a Shared Need
Shaping a Vision
Mobilizing Commitment
Changing Systems Structures
Monitoring Progress
Making Change Last
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WHAT YOU DONT KNOW COULD KILL YOU LEARN
WHAT YOU CAN DO TO PREVENT VTE TODAY.
Contact Information smindel_at_virtua.org
trodgers_at_virtua.org- jritzius_at_virtua.org