Stop the clot

Dr Maureen Baker CBE

In the latest of our columns from NHS Connecting for Health, Dr Maureen Baker CBE, clinical director for patient safety, talks about the work it has been doing to develop a risk assessment tool for Venous Thromboembolism (VTE).

Blood clot prevention is becoming a high profile issue for hospital trusts. Around 25,000 hospital deaths per year are caused by this condition, yet the thrombosis charity Lifeblood revealed last month that the public is largely unaware of the risk.

The NHS Confederation recently warned that trust boards must act to stop the issue becoming ‘the next MRSA’ in the eyes of patients and the general public.

Venous Thromboembolism (VTE), which manifests itself as either deep vein thrombosis for pulmonary embolism, has few specific symptoms and is difficult to diagnose.

The need to improve assessment of all patients and to use cost effective measures to prevent VTE is widely recognised, and IT is playing a key role in assessing patients’ risk of blood clot formation.

Developing an electronic risk assessment tool

Following a report by the Health Select Committee four years ago, the government recognised there was no systematic approach to identifying patients at risk from VTE in hospitals and there was significant room for improvement.

An independent expert group was set up to consider best practice and guidance and recommended that every hospital patient should have their own risk assessment for VTE.

As the clinical director for patient safety at NHS Connecting for Health, I am pleased by how closely the Clinical Safety Team at NHS CFH has worked with the Chief Medical Officer’s VTE Implementation Working Group on the development of a national VTE risk assessment tool for hospitalised patients.

The result of this work, based on evidence from scientific literature and extensive liaison with NHS professionals, is a common core dataset for an easy to use VTE electronic risk assessment tool for all adult hospitalised patients.

Potential IT solutions

We identified three discrete timeframes over which potential IT solutions could be delivered.

1. Short term (three months): an immediate solution providing stop-gap IT measures to support administering VTE risk assessments. The tool is deliberately low-tech, consisting of a simple personal digital assistant which links via Wi-Fi or Bluetooth to a stand alone printer that can be procured off the shelf and requires no network infrastructure. There is no patient identifiable data capture and the risk assessment checklist can easily be included in paper or electronic records.

2. Medium term (three to nine months): a checklist – as in the previous solution – is helpful but how do we ensure busy clinicians complete it? A series of small enhancements to existing patient administration system screens would embed VTE risk assessment into everyday working practice.

3. Long term: there is the potential to develop a dynamic VTE assessment on the Summary Care Record, with information on key criteria being extracted from GP systems. This would mean that when patients are admitted as an emergency, much of the essential information enabling clinicians to quickly conclude whether they are at risk from blood clots is already present in the SCR.

We are looking to provide a strategic, end-to-end solution which works throughout the patient’s journey from primary care to secondary care. A GP referral sent via Choose and Book would include information on the patient’s VTE risk.

The hospital PAS would extract and then automatically populate the VTE risk template and encourage risk assessment on admission. Electronic bed board processes would display patients’ VTE status and alert clinicians as to missing assessments.

Throughout a patient’s hospital stay, staff would be assisted by a combination of VTE guidance and decision support embedded in the PAS. Both the medication record and discharge summary would be automatically populated from VTE clinical information held in the patient record, with the patient’s summary VTE history and any assessments conducted during their inpatient treatment sent back to their GP.

Where do we go from here?

An e-learning tool to help healthcare professionals assess the risk of VTE and advise on preventative measures has now been launched as part of the Department of Health’s prevention strategy on VTE.

We are currently piloting both the short term and medium term solutions in front line clinical settings, before wider roll out. The testing will consider how the tool is used, how it will link to electronic prescribing and how fields can be pre-populated from the electronic medical record.

Outcomes from the completed pilots will be aligned with the DH’s initiative on VTE – expected in the autumn as is the publication of NICE clinical guidelines.

We will continue to work closely with system suppliers to ensure risk assessment facility is embedded in systems and likewise with GPs and suppliers of primary care systems to ensure that information from GP systems can automatically populate electronic risk assessment tools.

Engaging leaders

A one day leadership summit was recently hosted by the DH and the All-Party Parliamentary Thrombosis Group on ‘Venous Thromboembolism in the NHS’.

The summit provided NHS leaders with a high level overview of the need to improve the prevention and management of VTE in their organisations. We were able to demonstrate the short term VTE assessment tool and provide further details on the medium and long term solutions for VTE assessment.

The response from delegates at the summit was very positive, and the hands-on experience of how the short term tool will work showed how easily and quickly this can be integrated into hospital settings.

Delegates from several hospitals were so encouraged by the medium term solution that they volunteered to be pilot sites. I firmly believe that our work on providing VTE assessment tools will provide a step change in reducing risk to patients and ultimately save lives.