title: Risks, dangers and competing clinical decisions on venous thromboembolism prophylaxis in hospital care.
abstract: Drawing on wider sociologies of risk, this article examines the complexity of clinical risks and their management, focusing on risk management systems, expert decision-making and safety standards in health care. At the time of this study preventing venous thromboembolism (VTE) among in-patients was one of the top priorities for hospital safety in the English National Health Service (NHS). An analysis of 50 interviews examining hospital professionals' perceptions about VTE risks and prophylaxis illuminates how National Institute for Health and Clinical Excellence (NICE) guidelines influenced clinical decision-making in four hospitals in one NHS region. We examine four themes: the identification of new risks, the institutionalisation and management of risk, the relationship between risk and danger and the tensions between risk management systems and expert decision-making. The implementation of NICE guidelines for VTE prevention extended managerial control over risk management but some irreducible clinical dangers remained that were beyond the scope of the new VTE risk management systems. Linking sociologies of risk with the realities of hospital risk management reveals the capacity of these theories to illuminate both the possibilities and the limits of managerialism in health care.
authors.affiliation: Peninsula Collaboration for Leadership in Applied Health Research and Care, National Institute for Health Research, University of Exeter Medical School, Exeter, UK.
authors.forename: Olga
authors.initials: O
authors.lastname: Boiko
authors.forename: Rod
authors.initials: R
authors.lastname: Sheaff
authors.forename: Susan
authors.initials: S
authors.lastname: Child
authors.forename: Christian A
authors.initials: CA
authors.lastname: Gericke
mesh_terms: D026683:Advisory Committees; D003657:Decision Making; D003659:Decision Making, Organizational; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D061214:Patient Safety / Q000592:standards; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D036301:Qualitative Research; D012306:Risk; D012308:Risk Management; D013222:State Medicine; D054556:Venous Thromboembolism / Q000517:prevention & control*
keywords: NHS; clinical guidelines; hospital decision-making; risk management; risk theory; venous thromboembolism