A small Idaho hospital uses a national collaborative to engage staff in VTE prevention

Looking back, it’s clear that joining the QIO Learning Network’s national collaborative on preventing hospital-acquired venous thromboembolisms (VTE) was a turning point for Madison Memorial Hospital, a 69-bed facility in Rexburg, Idaho.

Before making the commitment to join the fast-paced collaborative, the hospital was struggling to improve its VTE measures and had a difficult time securing staff buy-in for process changes. Now, Madison boasts an 86% relative improvement in hospital-associated VTE incidence—and a new QI-focused culture is taking hold throughout the facility.

“They’ve gone gangbusters at this hospital,” Qualis Health QI consultant Jennifer Palagi, MPH BSN RN CIC, noted. “It’s great to see the start of something special.”

Nolan Bybee, Madison’s Performance Improvement Director, admits that many of the hospital’s previous change efforts left out key players. “Getting the right team to collaborate around a common goal was one of the most important successes,” he said.

Securing physician buy-in was crucial to implementing the collaborative’s primary intervention—a hospitalwide VTE prophylaxis protocol. The collaborative provided evidence regarding the efficacy of such a protocol, the severity of the problem nationwide, and ample opportunity to learn from peers, some of whom practiced in the same region as Madison’s physicians. Bybee observed that building doctor-to-doctor relationships helped Madison’s physicians “get on the same page” with the national effort.

Agreeing to implement the VTE best practice was not only a step toward better care for surgical patients, but it marked the first time ever that a facilitywide protocol—of any kind—had been adopted at the hospital.

Dorsie Sullenger, Madison’s Director of Pharmacy, described that Madison physicians were struck with the realization that the measures reported on the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare website weren’t just government paperwork but actual indications of quality that could directly affect their patients (and their patients’ choice of doctor). Building on the impact of the national reporting, Madison created physician-specific score cards. “The awareness is really there now,” Sandra Brown, RN, Madison’s Performance Improvement Specialist, said. “They know every detail of it.”

Physicians aren’t the only ones who have stepped up to the challenge of improving Madison’s VTE rates. According to Brown, the nurses are now more aware of the risks of immobility and encourage patients to get up and moving more often; plus they offer more detailed discharge instructions and send patients home with an instructional prophylaxis kit created by a drug vendor.

Bolstered by their VTE accomplishments, the hospital recently formed a Professional Clinical Quality Council (comprised of doctors, nurses, and pharmacy staff) that is starting to spread their learning to other important quality measures. “As a group, we can gain more knowledge and continually revamp,” Bybee said.