VTE and Health IT Supported Process for Preventing and Managing Venous Thromboembolism (VTE)

Overview: Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a frequent, but preventable complication for hospitalized patients. These complications lead to significant increase in morbidity and mortality. The overall age and sex-adjusted incidence of VTE is more than 1 per 1,000 annually. It has been estimated that more than 900,000 VTE cases occur in the US every year. Approximately sixty-percent of the people with VTE develop it during their hospitalization or within 30 days of hospitalization. In addition to its human costs, VTE represents a major economic burden from the initial hospital costs and the high rate of hospital readmissions (5-14%).

This project will implement a sociotechnical systems approach to the development of a health IT supported process for preventing and managing VTE.

Aims: The aims of this project are:

– to evaluate the cognitive and team work involved in VTE prevention (i.e. prophylaxis) and management (i.e. diagnosis and treatment) and

– to develop design requirements for a Clincal Decision Support that supports cognitive and team work for preventing and managing VTE.

Funding: Agency for Healthcare Research and Quality (AHRQ)

Pascale Carayon, PhD
Procter & Gamble Bascom Professor in Total Quality
Department of Industrial and Systems Engineering
Director, Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Roger Brown, PhD
Professor, School of Nursing
Director, Research Design Methodology and Statistics Unit
University of Wisconsin-Madison

Peter Hoonakker, PhD
Research Scientist, Associate Director of Research
Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Ann Schoofs Hundt, PhD
Research Scientist, Associate Director of Education
Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Peter Kleinschmidt, MD
Internal Medicine Resident
University of Wisconsin School of Medicine & Public Health

Megan Salwei
Research Assistant
Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Jason Stamm, MD
Attending Physician, Division of Pulmonary and Critical Care Medicine
Geisinger Medical Center, Danville, PA

Brian Patterson, MD
Faculty, School of Medicine and Public Health
University of Wisconsin-Madison

Yudi Wang
Research Assistant
Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Douglas Wiegmann, PhD
Associate Professor
Industrial and Systems Engineering
University of Wisconsin-Madison

2018

Hundt, A.S., Carayon, P., Stamm, J., Agrawal, V., Hoonakker, P.L.T. (2018). Roles and responsibilities in the VTE prophylaxis process. Paper presented at the IEA 2018, conference, Florence, Italy, August 26-30, 2018.

Salwei M.E., Carayon, P., Hundt, A.S., Kleinschmidt, P., Hoonakker, P.L.T., Patterson, B.W., Wiegmann, D.  (2018). Team Adaptation to Complex Clinical Situations: The Case of VTE Prophylaxis in Hospitalized Patients. In: Bagnara S., Tartaglia R., Albolino S., Alexander T., Fujita Y. (eds) Proceedings of the 20th Congress of the International Ergonomics Association (IEA 2018), pp. 248-254. IEA 2018, Florence, Italy, August 26-30, 2018. Advances in Intelligent Systems and Computing, vol 818. Springer, Cham. https://doi.org/10.1007/978-3-319-96098-2_32

Salwei, M., Hoonakker, P.L.T., Hundt, A.S., Kleinschmidt, P., Novak, C., Patterson, B., Pulia, M., Wang, Y., Wiegmann, D., Wirkus, E., and Carayon, P. (2018). Using a Human Factors Approach to Design a Pulmonary Embolism Computer Decision Support Tool for the Emergency Department. Poster presented at the 26th Annual Wisconsin Emergency Medicine Research Forum, March 15, 2018, Madison, WI.

Salwei, M., Hundt, A.S., Carayon, P., Kleinschmidt, P., Hoonakker, P.L.T. (Accepted for presentation). EHR supported activities for VTE prophylaxis: A case study. Poster accepted for presentation at the HFES Healthcare Conference, Boston, MA, March 26-28, 2018.

Wang, Y., Patterson, B., Ravi, S., Wiegmann, D., Hundt, A.S., Hoonakker, P.L.T., Kleinschmidt, P., Salwei, M., Wirkus, E., Carayon, P. (2018). EHR Flowchart of Information Search for Cues of PE Diagnosis in the ED. Poster presented at the 26th Annual Wisconsin Emergency Medicine Research Forum, March 15, 2018, Madison, WI.

Wang, Y., Patterson, B., Ravi, S., Wiegmann, D., Hundt, A.S., Hoonakker, P.L.T., Kleinschmidt, P., Salwei, M., Wirkus, E., Carayon, P., (Accepted for presentation). Information Fragmentation in the Electronic Health Record: The Case of PE Diagnosis in the ED. Poster accepted for presentation at the HFES Healthcare Conference, Boston, MA, March 26-28, 2018.

2017

Hundt, A.S., Carayon, P., Yang, Y., Stamm, J., Agrawal, V., Kleinschmidt, P., Hoonakker, P. (2017). Role Network Analysis of Team Interactions and Individual Activities: Application to VTE Prophylaxis Management. Proceedings of the HFES 2017 conference, Austin, TX, Oct 9-13, 2017, pp. 896-900.

Hoonakker, P.L.T., Hundt, A.S., Asan, O., Valdez, R., Yang, Y. & Rivera, A.J. (2017). Designing Health Information Technology from a Human Factors Perspective. Proceedings of the ACE-ODAM 2017 International Symposium on Human Factors in Organizational Design and Management (ODAM) conference, Banff, Canada, July 31-Aug 3, 2017, pp. 532-537.

Salwei, M., Carayon, P., Hundt, A.S., Hoonakker, P., Wirkus, E., Agrawal, V. , Stamm, J. (2017). Role Network Analysis of Critical Care Medicine Teams. Poster presented at the UW Health Quality Improvement Symposium, Madison, WI, May 11, 2017. Poster presented at the University of Wisconsin – Madison 6th Annual Symposium of Industrial Systems and Engineering Research, Design, and Practice, Madison, WI, Apr 19, 2017. Poster was awarded Industrial Systems and Engineering Research, Design, and Practice “Best Presentation and Discussion” award.

Wang, Y., Carayon, P., Ravi, S., Hundt, A.S., Wiegmann, D., Patterson, B., Hoonakker, P., Wirkus, E. (2017). Role Network Analysis for Team Interactions and Individual Activities: Application to PE Diagnosis in the Emergency Department. Poster presented at the UW Health Quality Improvement Symposium, Madison, WI, May 11, 2017. Poster presented at the University of Wisconsin – Madison 6th Annual Symposium of Industrial Systems and Engineering Research, Design, and Practice, Madison, WI, Apr 19, 2017. Poster presented at the WIHSE Inaugural Conference, Madison, WI, Mar 16-17, 2017.

2016

Hoonakker, P.L.T., Du, S., Hundt, A.S., Stamm, J., Patterson, B., Carayon, P. (2016). Perceived Effectiveness of Clinical Decision Support to Improve VTE Prophylaxis: A Comparison of Physicicans, Pharmacists and Nurses. Poster presented at the AMIA conference, Chicago, IL, Nov 12-16, 2016. Poster was awarded an AMIA Distinguished Poster Award.

Hundt, A.S., Hoonakker, P.L.T., Agrawal, V., Stamm, J., Patterson, B. & Carayon, P. (2016). Triggers in VTE Prophylaxis from a Sociotechnical System Perspective. Poster presented at the AMIA conference, Chicago, IL, Nov 12-16, 2016.

Patterson, B., Otles, E., Hundt, A.S., Hoonakker, P.L.T., & Carayon, P. (2016). Cues for VTE Diagnosis in the Emergency Department: A Sociotechnical Systems Approach for Clinical Decision Support. Poster presented at the AMIA conference, Chicago, IL, Nov 12-16, 2016. Poster was nominated for the AMIA Distinguished Poster Awards.

Gurses, A.P., Hundt, A.S., Steege, L., Valdez, R.S., Werner, N.E. (2016). Conceptualizing Sociotechnical System Boundaries in Healthcare Settings: Within and Across Teams, Organizations, Processes, and Networks. Paper presented at the HFES 2016 Annual Meeting, Washington, D.C., September 19-23, 2016.

Li, Y., Carayon, P., Hundt, A.S., Hoonakker, P.L.T. (2016). Team interactions and health IT use during multidisciplinary rounds in three inpatient services. Proceedings of the HFES conference 2016, Washington, D.C., September 19-23, 2016., pp. 513-517.

Li, Y., Carayon, P., Hundt, A.S., Hoonakker, P. (2016). Team Interactions and Health IT Use during Hospital Multidisciplinary Rounds. Paper presented at the HFES 2016 Annual Meeting, Washington, D.C., September 19-23, 2016.

2015

Carayon, P., Grepo, L., Patterson, B., Li, Y., Hundt, A.S., Cartmill, R.S., Hoonakker, P.L.T., Wood, K. (2015). Role Network Analysis of Venous Thromboembolism (VTE) Diagnosis in the Emergency Department. Paper presented at the ISCOME conference, Montecatini Terme, Italy, June 15-16, 2015.

Hoonakker, P.L.T., Carayon, P., Cartmill, R.S., Hundt, A.S., Grepo, L., Li, Y., Stamm, J., Wood, K. (2015). Communication Strategies for Venous Thromboembolism Prophylaxis. Paper presented at the ISCOME conference, Montecatini Terme, Italy, June 15-16, 2015.