Crew resource management and VTE prophylaxis in surgery: a quality improvement initiative

Am J Med Qual. 2011 Nov-Dec;26(6):423-32. doi: 10.1177/1062860611404694. Epub 2011 May 23.


Despite the availability of safe and effective prophylaxis, appropriate use of venous thromboembolism (VTE) prophylaxis in surgical patients remains suboptimal. Multifaceted quality improvement (QI) activities are needed for sustained improvement at the individual institution level. This work describes a QI initiative for VTE prophylaxis in surgery that combined clinical education with Crew Resource Management (CRM)--a set of principles and techniques for communication, teamwork, and error avoidance used in the aviation industry. Surveys of clinicians participating in the initiative demonstrated immediate and retained confidence and increased knowledge in identifying process-related factors leading to errors, applying CRM to patient care, and identifying VTE prophylaxis candidates and guideline-recommended prophylaxis regimens. Reviews of patient charts preinitiative and postinitiative demonstrated performance improvement in meeting guideline recommendations for the timing, inpatient duration, and use of VTE prophylaxis beyond discharge. This new model joins continuing medical education with CRM to improve the appropriate use of VTE prophylaxis in surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Communication
  • Education, Continuing / organization & administration*
  • Female
  • Guideline Adherence / organization & administration
  • Hospital Bed Capacity, 100 to 299
  • Hospitals, Community / organization & administration*
  • Humans
  • Length of Stay
  • Male
  • Medical Errors / prevention & control
  • Medical Staff, Hospital
  • Middle Aged
  • Nursing Staff, Hospital
  • Patient Care Team / organization & administration
  • Pharmacists
  • Physicians
  • Postoperative Complications / prevention & control*
  • Practice Guidelines as Topic
  • Quality Improvement / organization & administration*
  • Risk Factors
  • Venous Thromboembolism / prevention & control*