Improving venous thromboembolism performance: a comprehensive guide for physicians and hospitalists.

Venous thromboembolism (VTE) is a major potentially preventable cause of hospital deaths and is associated with a substantial clinical and economic burden in the United States. Despite the availability of effective thromboprophylactic agents and evidence-based management guidelines, VTE prophylaxis is commonly underused and inappropriately prescribed in real-world practice. Several US organizations have developed quality improvement initiatives to close the gap between guideline recommendations and clinical practice, and thus reduce VTE-associated morbidity and mortality. The Surgical Care Improvement Project and the National Quality Forum, in collaboration with The Joint Commission, have developed performance measures to allow assessment of the quality and appropriateness of VTE prevention practices. A number of potential barriers to optimal VTE performance exist, including underestimation of the risks posed by VTE, overestimation of the risk of bleeding complications, and a lack of familiarity with clinical guidelines. Hospitals are urged to develop an institution-wide policy to improve VTE prevention and employ several quality-improvement initiatives to overcome barriers and optimize prescribing practices. In particular, multiple integrated, active strategies are required to raise awareness of the need for appropriate VTE prophylaxis. Hospital-wide education, risk-assessment tools, electronic alerts, computerized decision-support systems, together with audit and feedback mechanisms, are valuable tools that can be used to promote the use of performance measures to drive improvement of VTE prophylaxis and clinical outcomes.