1. Preventing Hospital Associated Thrombosis: measuring outcomes Roopen Arya King’s College Hospital VTE Prevention NHS Showcase 16 September 2013

2. Link Nurse/ Midwives Link Nurse/ Midwives Patient information Patient information Thrombosis team Staff education RCA of HAT cases Electronic VTEp systems Electronic VTEp systems Audit programme VTE Prevention VTE Prevention Supportive managers Preventing VTE

3. VTE prevention: Measuring quality and outcomes Patient admitted to hospital Individual patient risk assessed for VTE Professional workforce aware of VTE risk Appropriate preventative strategy implemented Evaluation of outcome Process Measures VTE risk assessment Appropriate thromboprophylaxis NICE VTEp Quality Standard Process Measures VTE risk assessment Appropriate thromboprophylaxis NICE VTEp Quality Standard Outcome Measures Coding – HES / ONS Reporting through RCA programme Outcome Measures Coding – HES / ONS Reporting through RCA programme

4. Determining outcomes: Root cause analysis of cases of HAT DVT/AC clinic Autopsies DiagnosticsCoding HAT Thrombosis Team Data collection Notification Learning Trust Quality Framework Bereavement Other hospitals Admitting consultant

5. Hospital wide risk assessment rates P<0.001 % Median85.893.9 IQR72.0 - 90.492.3 94.5 (Roberts et al, Chest 2013)

7. Admission characteristics

8. VTE characteristics P=0.07 % Fatal PE 90d mortality % HAT presenting as PE Mortality associated with HAT n17125037

9. VTE risk assessment in HAT P<0.001 P=0.10

10. Appropriate thromboprophylaxis P= 0.001 % P= 0.24 TP prescribed (n)62915163 TP indicated (n)881028592

11. Underlying root cause % P=0.005P=0.031 P=0.063 P=0.49P=0.14

12. Mortality associated with HAT Most fatal PE in medical patients Post-op VTE: 6 deaths in 2010, 3 in 2011 9% medical HAT fatal, 4.7% surgical HAT Procedures: #NOF, abdominal hysterectomy, Achilles tendon repair, glioma for biopsy, Meningioma resection, prostatectomy, right hernia repair, sleeve gastrectomy 90-day mortality: medical 26% vs surgical 15%

13. HAT due to failure of thromboprophylaxis 43% HAT cases at King’s due to TP failure PE in 46% patients 79.4% episodes symptomatic Medical admission 44% Surgical admission 53% Median time to TP failure events 17d TP failure events were more common after hospital discharge

14. Thromboprophylaxis failure Mean number of risk factors higher in HAT due to TP failure HAT post-hip fracture surgery more likely due to inadequate prophylaxis than TP failure Increased risk in subgroups of surgical patients e.g those with dehydration or prolonged abdominal surgery In medical patients, increased age, dehydration and cardiorespiratory disease associated with TP failure

15. King’s HAT project: conclusions Electronic solutions with dedicated VTE training led to sustained improvement in risk assessment 20% reduction in overall HAT events Comprehensive VTE prevention significantly reduces preventable patient harm

16. Where we can improve Identifying those at risk for HAT Delivery of appropriate prophylaxis Better prophylaxis to reduce TP failure rates Address uncertainty regarding: Nursing homes Plaster casts Cancer Mental health

17. National VTE Registry

18. mdsas Medical data solutions and services VTE System Guide Username: Password: User Password

19. If the patient is already on the system, their details will appear automatically. If not you can enter the patient details here. Enter the VTE Event details.

23. www.vteprevention-nhsengland.org.uk roopen.arya@nhs.net