AORN Blog - The Periop Life

3 Ways Lean Thinking Can Prevent VTE

3 Ways Lean Thinking Can Prevent VTE

November 21, 2017     

Venous thromboembolism (VTE), which can result in deep vein thrombosis (DVT) or pulmonary embolism (PE), is considered a preventable hospital-acquired condition, yet fewer than half of hospitalized patients receive VTE preventive measures.1

Heather Hohenberger, MSN, RN, CIC, CNOR, CPHQ, FAPIC, administrative director of perioperative services at IU Health Arnett Hospital in Lafayette, Indiana recognized the opportunity to address this preventable patient risk within her multi-center hospital system using Lean concepts. She and her colleagues at IU Health have been using Lean to create standardized order sets and documentation practices with AORN’s updated guideline on VTE prevention. Hohenberger worked closely with AORN in shaping the updated guideline.

"Applying this Lean approach to standardize VTE prevention practices has really been about building processes into the system so you make it easier to do the right thing by consistently applying the right intervention, for the right patient, at the right time."

Here are three successful ways Hohenberger and her colleagues have used Lean principles to standardize VTE prevention practices.

Lean Principle #1: Respect People

The team acknowledged how frequently preoperative patients were asked the same questions by different providers to understand potential risks for VTE. So they implemented a standardized VTE assessment within the electronic health record that must be completed by any provider conducting the patient’s preoperative assessment. This assessment addresses the patient- and procedure-specific risk factors cited by AORN, with the identified risk factors being placed in a computer-generated algorithm that identifies the patient’s overall VTE risk.

Lean Principle #2: Standardize Work

Much like moving from physician-specific to procedure-specific physician preference cards (to reduce variability), Hohenberger and colleagues worked with surgical service lines to standardize order sets for VTE mechanical prophylaxis tied to a patient’s calculated VTE risk assessment. For example, all patients undergoing a hysterectomy procedure are at high procedural risk for VTE so each order set, no matter the physician, includes mechanical prophylaxis.

Lean Principle #3: Eliminate Waste

The outcome of standardizing VTE prevention practices has been an elimination of wasteful actions, such as eliminating the need for a nurse to speak up at the last minute as a case is preparing to start to request patient prophylaxis, which leads to surgical delays. This standardized approach to addressing VTE has also filled the gaps that previously allowed some patients to not receive VTE prevention, which has not only protected patients but has also reduced the need for extended length of stay.

Hohenberger will be presenting on the topic of lean thinking and creating standard work in the perioperative setting at AORN’s Global Surgical Conference & Expo on Saturday, March 24.

1Centers for Disease Control and Prevention. Venous thromboembolism (blood clots).