Bariatric Midtown team wins GA Hospital Association 2021 Patient Safety & Quality Award
JANUARY 2021
A team of Emory bariatric clinicians led by Elizabeth Hechenbleikner, MD, has received 1st place in the Georgia Hospital Association's 2021 Patient Safety & Quality Awards. The team represented Emory University Hospital Midtown, and was included in the category of hospitals with greater than 300 beds.
The team's study was "Improving Venous Thromboembolism Prophylaxis Compliance among Bariatric Surgery Patients." Dr. Hechenbleikner's co-authors were Melissa Majumdar, MS, RD, CSOWM, LDN, metabolic and bariatric coordinator; Edward Lin, DO, MBA, surgical director of the Emory Bariatric Center; Carla Smach, MSN, APRN, AGCNS-BC, clinical nurse specialist for the bariatric service; Sharon Jenkins-Green, BSN, RN, pre-op holding manager; Amber Davis, BSN, RN, pre-op holding manager; Tori Delgado, RD, CSOWM, LD, data analyst; Shanza Ashraf, BS, data analyst; and Theresa Evans, BSN, RN-BC, perioperative services nurse educator.
"The study evolved from our concern that perioperative administration of medications to prevent venous thromboembolism (VTE) events in bariatric surgery patients was inconsistent at Emory University Hospital Midtown," says Dr. Hechenbleikner. "While our VTE rates were well below national benchmarks, pulmonary embolism remains a leading cause of death after bariatric surgery."
With the goals of increasing perioperative dosing compliance by 50%, identifying key barriers to non-compliance, and tracking balance measures, Dr. Hechenbleikner and her multidisciplinary group convened to review the literature, share expert opinions, and consider VTE medication shortages. Then they developed a standardized VTE protocol of 5,000 units of preoperative subcutaneous (SC) heparin given within one hour of intubation, followed by an additional 5,000 units of postoperative SC heparin every eight hours after surgery. The protocol was distributed to all bariatric surgical clinicians and support staff.
Team members then assessed monthly compliance rates for four perioperative timeframes through chart review and identified barriers to non-compliance by interviewing clinicians. After ten months, compliance increased from 22% to 94%. Prior to the intervention, preoperative heparin was only given 17% of the time within 60 minutes of surgery, but by July 2020 administration rose to 87%.
When the study began in September 2019, 67% of patients received their first postoperative VTE dose an average of 21.4 hours after their preoperative dose. Since January 2020, more than 80% of patients have been receiving VTE prophylaxis on the day of surgery, with compliance nearing 100% for most of the following months. Current data reveal an average time of 11.2 hours between preoperative VTE prophylaxis and the first postoperative dose, down from over 21 hours pre-intervention. Patient-level VTE prophylaxis error rates decreased from 36% in February to 19% in July 2020.
Dr. Hechenbleikner and her collaborators found that the key barriers to noncompliance included nursing error, patient refusal, surgeon error, and medication default timing error. No VTE or clinically significant bleeding events requiring transfusion were identified during the study period.