Hospital acquired Hospital acquired

VTE Alert systemVTE Alert system

Caroline BaglinCaroline Baglin

Thrombophilia CNSThrombophilia CNS

‘Venous thromboembolism is the number one cause of unexpected hospital death… the disconnect between evidence & execution as it relates to DVT prevention amounts to a public health crisis. We need to deliver a more unified, co-ordinated & stronger message: VTE prophylaxis in high risk patients is mandatory, not optional’

Samuel Z Goldhaber 2007

The drive to setting up the system

Venous thrombosis: reducing the burden of disease

The 10 hurdles

• perception of problem by clinicians – belief• agreement on RAM• agreement on intervention• extended prophylaxis• who assesses & prescribes?• training & competency• implementation – compliance, documentation, monitoring• funding – not a DOH target• change management – NHS culture• patient empowerment & engagement

Why?

• Argument that surgeons state no VTE post their operations

• They do not class below knee DVT as a thrombosis

• Readmitted with VTE under physicians so don’t know follow up

• Different interpretations of Thrombophylaxis

Our Audit Outcome – Identifies patients with hospital

acquired VTEProcess – Looks to see if RAM was applied

Tells us: 1 Outcome reducing2 Is process being applied3 Is process effective

Identification

• ICD codes• Post mortem• Radiology• Outpatient anticoagulant service

ICD codes

• Permits tracking of new diagnoses • I26 pulmonary embolism• I80 thrombophlebitis

Post mortem reviews

Monthly listReview cause of death - PECould death have been prevented?Limitations

Radiology

• Monthly list of scans, CTPA, VQ, US

Outpatient anticoagulant service

All patients discharged from hospital and referred to clinic

All patients newly registered with service

LOOK BACK – LOOK BACK – Hospital Acquired VTEHospital Acquired VTE

Look Back – Hospital acquired VTE

Feedback to clinical staff- process & outcome

Profile the ‘at risk patient’

LOOK BACK – LOOK BACK – Hospital Acquired VTEHospital Acquired VTE

LOOK BACK – LOOK BACK – Hospital Acquired VTEHospital Acquired VTE

• This look back is sent on behalf of the Outpatient Anticoagulant Service. The purpose is to give feedback to Clinicians on process and outcome, and allow us to develop a better profile of the ‘at risk’ patients.

• Therefore the form should NOT be placed in patients hospital notes or recorded on EMR.

• Signed + Clinical directors name

Lessons learnt so far

• Surgeons

• Physicians

Conclusions

• Need more uniformity within Trust.• Thrombophylaxis in all ‘in patients’ needs to be

addressed to try to reduce death rate due to VTE.• Baseline assessment of the 50 clinical

directorates.

Will ‘Look Back’ change practice?

?