Venous thromboembolism

Venous thromboembolism (VTE) is a major cause of death in hospital patients, and there are considerable costs associated with non-fatal symptomatic VTE and related comorbidities. The first step in preventing death and disability is to identify those who are at risk so that preventative treatments can be used. The VTE risk assessment was formally a national Commissioning for Quality and Innovation (CQUIN) indicator and is a National Quality Requirement in the NHS Standard Contract for 2016/17. It sets a threshold rate that acute providers must undertake risk assessments for at least 95% of inpatients each month.

We also examine how deep vein thrombosis (DVT) rates after hip or knee replacement surgery compare internationally over time.

How has the rate of venous thromboembolism (VTE) risk assessment changed?

Since 2010/11 Q1, there has been an increase in the proportion of adult admissions being risk assessed for venous thromboembolism (VTE) across all providers of NHS-funded acute care. The 95% target was introduced in 2013/14 as part of the national VTE CQUIN goal, and the 95% threshold has been exceeded for all providers since 2013/14 Q1. In 2016/17 Q4, the proportion of adult inpatients who were risk assessed for VTE on admission to hospital was 95.5% for acute providers and 97.8% for independent sector providers.

Updated December 2017.

How does the UK's post-operative deep vein thrombosis rate compare internationally over time?

In the UK, the post-operative deep vein thrombosis (DVT) rate after hip or knee replacement surgery is relatively low compared to other countries. Between 2011 and 2015, the post-operative DVT rate in the UK decreased from 240 per 100,000 hospital discharges to 202 per 100,000 hospital discharges. In France, the rate appeared to be much higher, reaching 1,328 per 100,000 hospital discharges in 2015.

However, the OECD's Health at a Glance 2017 suggests that some of the observed variations in DVT rates may be due to differences in diagnostic practices across countries. For example, routine ultrasound screening can significantly increase the detection of DVT. Furthermore, caution is needed in interpreting the extent to which the data accurately reflects international differences in patient safety rather than differences in the way that countries report, code and calculate rates of adverse events.

Updated July 2018.

About this data

Adherence to national guidance around VTE risk assessment has the potential to save many lives each year.

The data presented here relates to the proportion of adult hospital admissions admitted during the analysis period who are risk assessed for VTE on admission to hospital according to the Department of Health/NICE National VTE Risk Assessment Tool.

All providers of NHS-funded acute hospital care (including foundation and non-foundation trusts and independent sector providers) are required to complete the data collection, which was mandated in June 2010.

OECD data:

Definitions and comparability for the international indicator are taken directly from the OECD report Health at a Glance 2017: OECD indicators. Detailed information about the definitions and the source and methods for each country can be found here. The surgical admission-based method uses unlinked data to calculate the number of discharges with ICD codes for deep vein thrombosis in any secondary diagnosis field, divided by the total number of discharges of patients aged 15 and older.

A fundamental challenge in international comparison of patient safety indicators centres on differences in the underlying data. Variations in how countries record diagnoses and procedures and define hospital admissions can affect calculation of rates. In some cases, higher adverse event rates may signal more developed patient safety monitoring systems and a stronger patient safety culture rather than worse care. There is a need for greater consistency in reporting of patient safety across countries and significant scope exists for improved data capture within national patient safety programmes.

Comments

As a recently-retired physician, I followed this directive as best I could in recent years.
Has there been any impact in outcomes from all this frenetic (& costly) activity - ie morbidity & mortality from VTE? I haven't seen any evidence to support this.

Kit Byatt (not verified)
(changed )

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