T. S. Dharmarajan, MD
In January 2007, Internal Medicine residents at Montefiore Wakefield began formalized training to assess and prevent deep vein thrombosis (DVT) in all Department of Medicine hospitalized patients. This was added to a standardized form that is completed on every inpatient by the resident on each team detailing the nationally-endorsed performance measurements that apply to each patient (e.g. aspirin for MI or ACE/ARB for heart failure patients) as well as appropriate immunizations, advance directives, smoking cessation counseling and DVT risk assessment and prophylaxis. This effort is complement with a resident elective to monitor performance improvement (PI) in which data were collected weekly using the 'care measures form' is analyzed for performance patterns and improvement opportunities are identified.
As of January 2009, nearly 11,000 hospitalized patients had been monitored for DVT risk. Throughout the 2-year period, the percentage of patients identified to be at risk for DVT and given appropriate preventive treatment increased significantly, suggesting that repetitive formal education, monitoring and supervision of trainees improved compliance with DVT risk assessment and prophylaxis; a standardized form in each patient's chart provided for easy implementation of monitoring, and having senior trainees (chief residents and fellows) gather the data impressed trainees of its importance.
The DVT project won second prize at the 2009 Bronx City Society meeting, and was accepted for presentation at the 2009 American College of Physicians New York Chapter meeting.
The specialized performance improvement resident elective continues with expansion into measures and projects pertaining to the ambulatory setting as well as electronic data collection.