Journal of General Internal Medicine

, Volume 22, Issue 12, pp 1762–1770 | Cite as

Bridging the Gap Between Evidence and Practice in Venous Thromboembolism Prophylaxis: The Quality Improvement Process

  • Franklin A. MichotaEmail author
Clinical Review


Venous thromboembolism (VTE) is considered to be the most common preventable cause of hospital-related death. Hospitalized patients undergoing major Surgery and hospitalized patients with acute medical illness have an increased risk of VTE. Although there is overwhelming evidence for the need and efficacy of VTE prophylaxis in patients at risk, only about a third of those who are at risk of VTE receive appropriate prophylaxis. To address the shortfall in VTE prophylaxis, the US Joint Commission and the National Quality Forum (NQF) endorse standardized VTE prophylaxis practices, and are identifying and testing measures to monitor these standards. Hospitals in the USA accredited by Centers for Medicare and Medicaid Services to receive medicare patients will need VTE prophylaxis programs in place to conform to these national consensus standards. This review aims to give background information on initiatives to improve the prevention of VTE and to identify key features of a successful quality improvement strategy for prevention of VTE in the hospital. A literature review shows that the key features of effective quality improvement strategies includes an active strategy, a multifaceted approach, and a continuous iterative process of audit and feedback. Risk assessment models may be helpful for deciding which patients should receive prophylaxis and for matching VTE risk with the appropriate intensity of prophylaxis. This approach should assist in implementing the NQF/Joint Commission-endorsed standards, as well as increase the use of appropriate VTE prophylaxis.


venous thromboembolism prevention prophylaxis quality improvement 



The author received writing/editorial support in the preparation of this manuscript, funded by Sanofi-Aventis, NJ, USA. Hester van Lier, PhD provided writing/editorial support.

Potential conflicts of interest

Dr Michota has acted as a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, GlaxoSmithKline, Bacchus Vascular, Inc., and AstraZeneca.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  1. 1.Section of Hospital Medicine, Department of General Internal MedicineCleveland ClinicClevelandUSA

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