Stop the Clot: A Quality Improvement Initiative to Reduce the Rate of Venous Thromboembolism in the PICU

Objectives: We aimed to reduce the rate of hospital-acquired venous thromboembolism (HA-VTE) in the PICU by 50% from 2.07 to 1.04 venous thromboembolism (VTE) per 1000 patient days by June 2023 and sustain this change for 6 months. Design: Prospective quality improvement project. Setting: The PICU of an urban academic free-standing children’s hospital in the United States. Patients: All patients admitted to the PICU between December 2020 and December 2023. Interventions: We identified key drivers including: provider knowledge gaps surrounding VTE risk in our patient population, identification of patients at risk of VTE, the absence of appropriate screening and prevention tools, and central venous line duration and location. These key drivers were each addressed with the most significant intervention being the creation of a simple screening tool to identify and provide thromboprophylaxis recommendations for patients most at risk for developing VTE. Measurements and Main Results: We identified the monthly occurrence rate of VTE as our outcome measure, the provision of VTE thromboprophylaxis as our process measure and the presence of bleeding events as our balancing measure. The rate of VTE in PICU patients decreased from 2.07 to 1.14 per 1000 patient days. There was an increase in the provision of pharmacologic thromboprophylaxis during our intervention period from 36% to 42% with no change in the rate of mechanical thromboprophylaxis. There were only two instances of clinically relevant non-major bleeding as defined by the International Society of Thrombosis and Haemostasis definition in nonsurgical patients on anti-hemostatic agents during our intervention period. There was a decrease in central venous catheter days from 43% to 31% of PICU patient days during the intervention period. Conclusions: Upon implementing a protocolized screening and prevention tool for VTE, we observed a decreased occurrence of HA-VTE.