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Developing a systems-based approach to VTE a UK perspective Dr Anita Thomas OBE, UK

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a UK perspective Dr Anita Thomas OBE, UK Developing a systems-based approach to VTE a UK perspective Modern understanding of VTE Natural history Methods of ... – PowerPoint PPT presentation

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Title: Developing a systems-based approach to VTE a UK perspective Dr Anita Thomas OBE, UK


1
Developing a systems-based approach to VTE a UK
perspective Dr Anita Thomas OBE, UK
2
Developing a systems-based approach to VTE a UK
perspective
  • Modern understanding of VTE
  • Natural history
  • Methods of prevention and
  • treatment
  • Professor Vijay Kakkar
  • NHS research in 1970-80s
  • Medical Research Council
  • Low dose low mol wt heparins
  • global gold standard treatment

3
Developing a systems-based approach to VTE a UK
perspective
Health Committee
Health Committee
4
Developing a systems-based approach to VTE a UK
perspective
  • 2005 UK House of Commons Health Committee VTE
    Report
  • Each year over 25,000 people in England die from
    venous thromboembolism (VTE) contracted in
    hospital
  • More than combined total of deaths from breast
    cancer, AIDS and traffic
  • accidents, more than twenty-five times the
    number deaths from MRSA
  • Figures alarmingly high. Many of these deaths
    are preventable
  • Safe, efficacious and cost effective method of
    preventing venous
  • thrombosis not as widely administered as
    should be

5
Developing a systems-based approach to VTE a UK
perspective
6
Developing a systems-based approach to VTE a UK
perspective
  • UK Governments formal response to Health
    Committee
  • Government agrees with Health Committee that much
    more needs to be done - too many preventable
    deaths from venous thromboembolism in
    hospitalised patients
  • Health Committees estimate of 25,000 deaths a
    year due to VTE is a serious issue which requires
    rapid and comprehensive action
  • Welcome advice and information Health Committee
    provided

7
Developing a systems-based approach to VTE a UK
perspective
  • Recognise there is no systematic approach to
    identifying and treating those patients at risk
    from VTE in hospitals - significant room for
    improvement
  • Not just people at risk from developing VTE in
    hospitals need to ensure robust risk assessment
    but also consider people with existing VTE
    conditions

Bergan et al NEJM 355 488-498
8
Developing a systems-based approach to VTE a UK
perspective
  • Chief Medical Officer (CMO) England, Professor
    Sir Liam
  • Donaldson established an independent expert
    working group
  • consider how current best practice and guidance
    can be promoted and implemented
  • what resources might be needed to support
    delivery of strategy through existing structures
  • include consideration of need to promote or
    clarify existing guidance
  • on use of
  • mechanical devices (foot-pumps)
  • aspirin
  • other pharmacological preparations (heparin or
    other antiXa agent)

9
Developing a systems-based approach to VTE a UK
perspective
  • The National Institute for Health and Clinical
    Excellence (NICE) working closely with CMOs VTE
    Implementation Working Group
  • NICE recently published guidelines on VTE for
    surgical inpatients in England and Wales - in
    2009 are due to publish guidance for all
    hospitalised patients
  • Suite of guidance will provide an important
    contribution to national VTE Strategy in England

10
Developing a systems-based approach to VTE a UK
perspective
  • VTE expert group considered best existing
    guidelines
  • for thromboprophylaxis
  • All medical patients
  • Intermediate-risk surgical patients
  • Low risk surgical patients

11
Developing a systems-based approach to VTE a UK
perspective
  • Report of the VTE expert group published by the
    Chief
  • Medical Officer/Department of Health on 19 April
    2007

12
Developing a systems-based approach to VTE a UK
perspective
  • CMO announcement
  • Every hospital patient must be assessed to
    prevent
  • potentially fatal blood clots
  • Widespread media coverage across England
  • National newspapers
  • The Times Guardian Daily Telegraph
    The Sun
  • National online
  • BBC.co.uk
  • National regional broadcast
  • BBC News 24 Sky News Radio Sky News BBC
    Radio 2 Heart 106
  • Specialist magazines
  • BMJ, Hospital Doctor, The House, Health Services
    Journal
  • Regional newspapers

13
National Specialist Media Coverage
The House Magazine 7 May 2007
The Daily Telegraph 20 April 07
The Times 20 April 07
The Guardian 20 April 07
BBC News Online 19 April 07
14
Developing a systems-based approach to VTE a UK
perspective
  • Key recommendations of the report
  • A VTE risk assessment of every patient on
    admission to hospital in England
  • Raising awareness and improving understanding of
    VTE by patients public and professionals
  • Establishing exemplar centres to share best
    practice throughout the NHS and wider healthcare
    settings

15
Developing a systems-based approach to VTE a UK
perspective
  • Recommended effective preventative measures
  • For medical patients, particularly those at
    increased risk, low dose heparins
  • For intermediate surgical risk patients (or any
    surgical patients with concomitant medical
    conditions) low dose heparins and graduated
    stockings
  • Low risk surgical patients do not require
    specific prophylaxis
  • Aspirin is not recommended for medical patients
    or for intermediate and low-risk surgical
    patients

16
Developing a systems-based approach to VTE a UK
perspective
  • Government announces a national strategy for VTE
  • June 2005 Government published response to Health
    Committee on the prevention of venous
    thromboembolism in hospitals
  • Established an independent expert working group
    to make recommendations on developing a national
    strategy on the prevention and treatment of
    venous thromboembolism (VTE)
  • Report and recommendations of the expert group
    presented to the CMO in July 2006

17
Developing a systems-based approach to VTE a UK
perspective
  • It is clear from the expert group's report that
    introducing a VTE risk assessment for all
    patients on admission has the potential to save
    thousands of lives every year
  • We have therefore established an implementation
    working group which will develop a national risk
    assessment tool, and will provide leadership both
    within the NHS and the wider healthcare sector to
    assess what needs to be done to ensure that a VTE
    risk assessment of every patient on admission to
    hospital becomes a reality

18
Developing a systems-based approach to VTE a UK
perspective
UK Government and CMO consider VTE a major
patient issue
  • Common
  • Silent
  • Difficult to predict
  • Preventable
  • High risk is identifiable
  • High cost of inaction

19
Developing a systems-based approach to VTE a UK
perspective
  • COMMON
  • 25,000 VTE hospital deaths 50,000 hospital
    community in England
  • 1 in 5 medical patients develop VTE if no
    prophylaxis
  • Around 1 in 4 of all VTE (hospital and community)
    occur in medical patients in hospital

20
Developing a systems-based approach to VTE a UK
perspective
  • SILENT
  • DIFFICULT TO PREDICT
  • Less than 1 in 10 fatal pulmonary emboli
    diagnosed before death

21
Developing a systems-based approach to VTE a UK
perspective
  • AT RISK
  • Medical patients
  • ¾ of all fatal PEs occur in patients admitted for
    non surgical reasons
  • Admission with acute medical illness increases
    risk x 8
  • Risk often unrecognised by clinicians
  • Immobility Older patients Chronic Disease
  • Risk profile similar to heart disease and stroke
  • Surgical patients
  • Immobility Individual risk Procedures

22
Developing a systems-based approach to VTE a UK
perspective
  • COSTLY
  • Lives and long term illness of people of all ages
  • Total cost of managing VTE around 640m (appx
    936m Euros) in UK each year
  • At least 68m (appx 100m Euros) paid or
    outstanding for litigation re VTE related
    conditions over last 10 years

23
Developing a systems-based approach to VTE a UK
perspective
  • National VTE Strategy in England
  • September 2007 to end of 2009
  • CMOs VTE Implementation Working Group developing
    a national VTE risk assessment tool to be made
    available by Government to all hospitals (NHS and
    others)

24
Developing a systems-based approach to VTE a UK
perspective
  • Hospitals in England risk assess all patients on
    admission by end of 2009
  • Exemplar VTE sites (hospitals, Primary Care
    Trusts) promote best practice
  • Current exemplar VTE hospitals Kings College
    Hospital London (NHS) and the London Clinic
    (Independent Sector)
  • Information on national risk assessment tool and
    exemplar sites to be made available on Department
    of Health VTE web pages - www.dh.gov.uk/vte

25
Developing a systems-based approach to VTE a UK
perspective
  • Encouraging high quality research and innovation
    within the NHS
  • Providing leadership by working closely with key
    stakeholders including professional bodies and
    societies

26
Developing a systems-based approach to VTE a UK
perspective
  • Catalyst for patients and patient representative
    organisations to influence VTE prevention at
    hospital level.
  • VTE Implementation Working Group in England
    partnered with Plymouth Hospitals NHS Trust and
    the Thrombosis Research Institute, London

27
Developing a systems-based approach to VTE a UK
perspective
Patient admitted to hospital
What will success look like?
Professional workforce aware of VTE risks Able
to institute timely prophylaxis
Individual patient risk of VTE assessed
Appropriate preventative strategy implemented
Evaluation of outcome
28
Developing a systems-based approach to VTE a UK
perspective
  • Prevention of VTE is emerging as a major patient
    safety issue across Europe
  • CMO for Englands VTE Implementation Working
    Group welcomes the opportunity to share our
    experience and learn from those of other European
    countries
  • Developing and implementing a national strategy
    to reduce the many thousands of avoidable deaths
    from VTE in hospitalised patients

29
Developing a systems-based approach to VTE a UK
perspective Dr Anita Thomas OBE, UK
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