The impact of the DoH Commissioning for Quality and Innovation incentive on the success of venous thromboembolism risk assessment in hospitalised patients. A single institution experience in a quality outcome improvement over a 4-year cycle.
OBJECTIVE
To i) demonstrate compliance with the Commissioning for Quality and Innovation for venous thromboembolism risk assessment ii) to undertake root cause analysis of Hospital Acquired Thrombosis and to investigate its impact on quality of care.


METHODS
Prospective monitoring of all admissions.


METHODS
Imperial College Healthcare Hospitals, London.


METHODS
All Hospital Provider Spells as defined on the NHS Data Model and Dictionary.


METHODS
i) Percentage of patients undergoing Venous Thromboembolism Risk Assessment (VTE-RA) at and 24-hours after admission ii) root cause analysis of Hospital Acquired Thrombosis up to 90 days following discharge.


RESULTS
Over a 48-month cycle 83% were overall VTE-RA assessed with 36% in the first 12 months but with significant improvement to ≥95% between April 2013 and April 2015, achieving compliance target since April 2012 involving a massive 633, 850 Spells over the 4 year period. We undertook root cause analysis of all VTE episodes from April 2013 to March 2014, to ascertain Hospital Acquired Thrombosis (HAT), we analysed 433, 174 inpatient days and found a HAT rate of 1 per 1000 with 23% and 24% for DVTs and PEs potentially avoidable respectively. We further analysed VTE risk stratification (n = 1000) and found 37.0% at high risk, 44.4% at medium risk and 18.6 % at low risk, indicating the need of thromboprophylaxis in 81.4% (high and medium) of whom 33.6% were excluded.


CONCLUSIONS
We achieved 95% RA compliance which has favourably impacted on our daily practice and improved the quality of the clinical care.
Department of Haematology, Haemostasis and Thrombosis section.
Abdul
A
Shlebak
Nursing Directorates.
Polly
P
Sandhu
Nursing Directorates.
Vernisha
V
Ali
Department of Information & Technology.
Garth
G
Jones
VTE lead, Department of Cardiology, Imperial College Healthcare NHS Trust Hospitals, Praed Street, London, UK, W2 1NY.
Christopher
C
Baker
C-QUIN; Thromboprophylaxis; Venous thromboembolism; deaths; hospital acquired thrombosis; risk assessment tool