Cardiac Step-Down Unit (CSU), Two Failures Drive Suboptimal VTE Prevention: Quality Improvement

Authors

Jorim Parmar, HCA HealthcareFollow
Shakir Al-Ezzi, HCA HealthcareFollow
Anvi Manduva, HCA HealthcareFollow
Muhammad Suleman, HCA HealthcareFollow
Fahed Alsayed, HCA HealthcareFollow
Debra Medsker, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Internal Medicine

Document Type

Presentation

Publication Date

2026

Keywords

quality improvement, venous thromboembolism, VTE, sequential compression device, SCD

Disciplines

Cardiology | Equipment and Supplies | Internal Medicine | Medicine and Health Sciences | Quality Improvement

Abstract

BACKGROUND: In the Cardiac Step-down Unit (CSU), two failures drive suboptimal VTE prevention: (1). over-ordering of SCDs in patients unlikely to benefit and (2). < 10% documented application when SCDs are truly indicated. Baseline data indicates that curbing over-ordering alone would reduce recorded non-compliance by >50%, revealing a clear opportunity for system redesign.

METHODS: To integrate the updated “3 Bucket” Risk Model assessment into the computerized physician order entry (CPOE) in order to delineate the prophylaxis for a given patient population. Once the manual risk assessment proves to be viable in increasing compliance, we can propose having the tool adopted into the CPOE system. Root Cause Analysis revealed that lack of standardized VTE risk stratification leads to inconsistent ordering practices – some patients receive unnecessary SCDs while others who need them are missed. In addition, nursing compliance with SCD application and documentation is poor, in part due to unclear prioritization and workflow barriers. To address these issues, we propose to implement the updated “3 Bucket” Risk Model as a standardized assessment tool. To address this, we propose that the “3 Bucket” VTE Risk Model will be embedded into the computerized physician order entry (CPOE) system. This integration ensures that appropriate prophylaxis (chemical vs. mechanical) is selected at the time of order entry, which should reduce unnecessary SCD use and improve compliance with indicated devices.

RESULTS: Overuse measure: % of patients with unnecessary SCD orders (patients already appropriately receiving chemical prophylaxis or low risk). Underuse measure (compliance): % of patients with indicated SCD orders who did not have devices applied and documented. In the 3 months prior to the project, compliance with initiated SCD use is < 10%. This poses a dual problem: (1) unnecessary SCD orders add cost and workload without benefit, and (2) underuse of SCDs in patients contraindicated for chemical prophylaxis places high-risk patients at avoidable risk for VTE.

CONCLUSION: Lack of standardized risk stratification leads to both over-ordering of SCDs in low-risk patients or those already on chemical prophylaxis. When SCDs are indicated (e.g. chemical prophylaxis contraindicated), nursing compliance with device application/documentation is < 10%.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Parmar, Jorim; Al-Ezzi, Shakir; Manduva, Anvi; Suleman, Muhammad; Alsayed, Fahed; and Medsker, Debra, "Cardiac Step-Down Unit (CSU), Two Failures Drive Suboptimal VTE Prevention: Quality Improvement" (2026). North Texas Research Forum 2026. 78.
https://scholarlycommons.hcahealthcare.com/northtexas2026/78