Today’s busy physician is inundated with numerous demands, from maintaining compliance with various regulatory mandated quality initiatives to meeting state licensing continuing medical education requirements. Any initiative that can effectively “kill two birds with one stone” is appreciated by physicians and health organizations alike.
At the University of Kansas Hospital (KUH), data revealed a sub‐optimal incidence of venous thromboembolism (VTE) in the hospital setting. An interprofessional, multidisciplinary team was formed, at the direction of hospital administration, to determine root causes of this finding and to develop educational and system‐based modifications to address these causes.
The charts of 261 patients with a secondary diagnosis of VTE (patients with VTE present at admit were excluded) were reviewed post‐discharge using a team‐developed standardized tool. Themes associated with the development of VTE included malignancy, presence of a peripherally inserted central catheter (PICC), lack of prophylaxis, and interruption in prophylaxis. The Associate Dean of Continuing Medical Education (CME) led the team in reviewing and implementing a variety of evidence‐based educational delivery methods. A matrix of methods to change provider behavior, as described by the Pathman/PRECEDE theoretical framework, focused on interventions coupled to the learners’ stage of acceptance of change, was developed to guide the broad educational plan. A PICC/VTE subcommittee was formed to develop standardized, evidence‐based guidelines for PICC usage, which were disseminated through print and podcasts. Other educational efforts included the development of “badge buddies” (small durable reference cards that can be attached to identification badges), resident education on VTE prophylaxis at the time of initial orientation, presenting compliance data to individual departments, development of a VTE website maintained by pharmacy, VTE‐ themed screen savers on hospital computers, and multiple articles in hospital publications. Clinical pharmacists, in addition to physicians, were tasked with incorporating daily surveillance of VTE prophylaxis into their rounding workflow using the EMR. An hour long, multidisciplinary, case‐based patient safety conference with continuing education credit was given for physicians, nurses and pharmacists, with over 300 professionals in attendance. Offering continuing education credit was a vital component to the success of this effort, as was providing lunch to attendees. The continuing education presentation received high marks from participants.
Our efforts resulted in hospital VTE rates dropping from 12.68 per 1,000 patients in December 2010 to 6.10 per 1,000 patients in June of 2012. PICC line insertion rates decreased by almost half during the same time period.
Our experience illustrates that closely aligning continuing education with quality improvement is beneficial in more ways than one, filling the needs of today’s busy physician in complying with state licensing continuing medical education requirements while increasing the quality of care that hospitalized patients receive.