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Original research article
Significant reduction in hospital-acquired thrombosis: impact of national risk assessment and real-time feedback
  1. Huw Raymond Rowswell and
  2. Timothy J C Nokes
  1. Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK
  1. Correspondence to Mr Huw Raymond Rowswell; huw.rowswell{at}nhs.net

Abstract

Objective Since 2010, National Health Service hospitals in England have been incentivised to risk assess for Venous Thromboembolism (VTE) in all adult patients admitted, using a national tool. We studied the impact of this, together with local real-time reporting of VTE events to senior clinicians, on cases of hospital-acquired thrombosis (HAT) diagnosed, since 2010.

Methods This was an observational cohort study reviewing all cases of VTE diagnosed between January 2010 and December 2016 in a single teaching hospital. These were matched against the number of patients admitted to produce crude incidence rates per thousand admissions. Similarly, all cases associated with inadequate thromboprophylaxis (TP) measures were documented over the same period.

Results By the end of 2010, with 70% compliance with VTE risk assessment, improving to 90% (the national target) early in 2011, there were 217 HAT events from 103 845 admissions. In 2016, there were 176 HAT events from 119 128 admissions, being a significant reduction, relative risk (RR) 0.718 (95% CI 0.589 to 0.875; p=0.001). In 2010, there were 50 of 217 HAT events associated with inadequate TP, falling to 7 of 176 in 2016, also a significant reduction, RR 0.140 (95% CI 0.065 to 0.300; p=0.0001).

Conclusions National guidance on VTE prevention and mandatory risk assessment linked to local real-time reporting of VTE events are associated with significant reductions both in total HAT events and those associated with inadequate TP.

  • epidemiology
  • deep vein thrombosis
  • venous thromboembol

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors HRR collected the data and calculated the statistics; TJCN checked the statistics; HRR and TJCN wrote and reviewed the paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are provided within the results section of the paper in full covering total annual admissions, total number of hospital associated thrombosis and total events associated with inappropriate care. Other documents that are available are the root cause analysis template and the standard letters sent to clinicians regarding HAT events. These documents are available immediately after publication by email request to the corresponding author.

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