Using a framework for spread of best practices to implement successful venous thromboembolism prophylaxis throughout a large hospital system

Abstract

Best practices take time to spread passively, at times contributing to suboptimal results in health care. Managed diffusion, often referred to as "spread," may hasten broad-scale implementation of best practices. At our institution, appropriate use of venous thromboembolism (VTE) prophylaxis had been markedly improved in select areas by 2 independent quality improvement teams. We wanted to accelerate the adaptation of those locally learned best practices across our entire institution and did so by following an explicit framework for spread. We report our experience using this framework, noting both how the framework helped anticipate needs and what challenges we encountered that were not anticipated based on the spread plan. Using our framework, we were able to spread the changes across more than 79 distinct hospital services, improving use of appropriate VTE prophylaxis to more than 95%. Use of an explicit, well-constructed spread plan allows for an orderly management of diffusion of best practices.