Millions of patients are not being given mandatory life-saving thrombosis risk-assessments because hospitals in England are failing to follow NHS guidelines, says a new parliamentary report.
Despite the government’s prioritisation of hospital-acquired blood-clot prevention this January, implementation has been slow; only 14 acute trusts in England are even close to meeting goals to risk-assess 90% of patients admitted to hospital to protect them from venous thromboembolism (VTE), the UK’s biggest hospital killer which could claim up to an estimated 25,000 lives each year, says the report, from the All Party Parliamentary Thrombosis Group (APPTG).
This means that as many as eight million patients are missing out on potentially life-saving preventative assessments to diagnose thrombosis (blood clots) - also known as deep vein thrombosis (DVT) and pulmonary embolism (PE), the study adds.
The 42-page report is based on replies to a Freedom of Information (FOI) request by 140 out of 152 of England’s NHS acute trusts. It found that just 14 acute trusts are coming even close to meeting the government goal to risk-assess 90% of patients. The 14 managed to risk-assess 80% or more of patients, meaning that 126 - 90% of all trusts - are still a long way off meeting best practice.
The study also reveals that: - in July 2010, the average risk-assessment rate in acute trusts stood at just 37%; - 21 acute trusts (15%) are in breach of National Institute for Health and Clinical Excellence (NICE) guidelines that recommend additional information be provided to patients on VTE on discharge, and the trusts also say that they have “no plans” to rectify this; - 68% of acute trusts cannot provide data on the number of patients who receive appropriate preventative treatment (prophylaxis) for VTE, despite this being a legal requirement under the NHS Standard Contract for Acute Services; and - 80% of acute trusts are failing to undertake an analysis of all confirmed VTE cases, despite this being a contractual obligation in the NHS Standard Contract for Acute Services.
The report coincides with the publication of new government figures on the number of patients diagnosed with a blood clot in hospital, which show that more than 60,000 people suffered from the condition in England in 2008-09 (the latest date range available). As the immediate cause of death in 10% of all patients who die in hospital and those who die in the three months after admission, blood clots are the number one greatest cause of preventable hospital mortality. This death rate is greater than the combined total of deaths from breast cancer, AIDS and traffic accidents and is estimated to be two to three times greater than the total of all hospital acquired infections, estimated at 10,000 deaths per year, according to campaigners.
“The government has set the bar very high for VTE prevention which is commendable, but it is clear that many hospitals are falling way short of what is expected of them in terms of ensuring swift risk assessment and prevention of thrombosis,” commented APPTG chair Andrew Gwynne, who is Labour MP for Denton and Reddish. “Urgent action must be taken to ensure clinicians and medical professionals are better supported in undertaking their responsibilities to hospital patients in terms of both initial and ongoing thrombosis risk-assessment,” he added.
Hematologist Professor Beverley Hunt, who is director of the thrombosis charity Lifeblood, described the statistics as “staggering. We are worried that trainee doctors, nurses and pharmacists are not being given the basic mandatory training to diagnose and prevent blood clots, and that is something that must be addressed urgently if we are to reduce the death rate. If not prevented, thrombosis is an indiscriminate and devastating killer,” said Prof Hunt.
The APPTG report makes a series of recommendations, including: - extending the national Commissioning for Quality and Innovation (CQUIN) goal to include measurements for successful preventative treatment in addition to the current risk-assessment measure; and - making education on VTE diagnosis and prevention mandatory for undergraduate and post-graduate health professionals.