Blood Clots Continue To Kill UK Hospital Patients Unnecessarily

Main Category: Vascular
Also Included In: Public Health;  MRSA / Drug Resistance
Article Date: 19 Nov 2007 - 12:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

An All-Party Parliamentary Report published exposes NHS Trusts in unnecessary DVT deaths. Over 10,700 hospital patients may have died as a result of NHS Trusts' failure to implement key recommendations on DVT published over seven months ago.1, 2

- Unnecessary deaths from DVT in the last seven months may equate to nearly three times the number of deaths from hospital acquired infections, such as MRSA and C Difficile*1,2,3

- The NHS currently spends only £27.4m per year on DVT prevention (projected to rise to just £50m over the implementation period of the recommendations)4

- The NHS has recently announced additional funding of £270m to prevent deaths from hospital superbugs by 20115

- 99% of NHS Trusts admit to being fully aware of the recommendations on how to manage and treat DVT1

- Only 32% of trusts are taking steps to risk assess patients and bring their practices in line with new recommendations1

- DVT causes 10% of all hospital deaths per year6

"DVT causes over 25,000 deaths each year 2" commented John Smith, MP. "It is worrying that some NHS trusts are still failing to adhere to these guidelines, which could reduce deaths by over 40%2. It took the Chief Medical Officer (CMO) 18 months to comment on the House of Commons Select Committee report into DVT - how long will it take for NHS Trusts to start acting on this guidance and start saving lives?"

52% of hospitalised patients are at risk of developing DVT**7, but today's report showed that less than half will be made aware of the risks1 and only a third will be risk assessed by a healthcare professional to confirm if they should receive life-saving preventative treatment for DVT.1 DVT has a mortality rate of 30% when left untreated, but this drops to just 2-8% with appropriate therapy.8

Dr Beverley Hunt, Medical Director of Lifeblood commented, "The total costs of managing DVT within the NHS are estimated to be £640 million*** 2 and it's deeply concerning that the simple step of risk assessing patients is not being taken. Any unwell adult entering a hospital bed has a 17% risk of DVT2, but this risk rises considerably if you are over 40, are having surgery or have a pre-disposing condition such as cancer."

The All-Party parliamentary Thrombosis Group (APPTG) is meeting today to make a call to action for implementation of these recommendations to become mandatory. The report highlights that key barriers to risk assessment are three-fold: a lack of centralised risk assessment tools, resource constraints surrounding implementing risk assessment and the costs of training staff.

Download the report at www.dvtreport.com Notes: - The All-Party Parliamentary Thrombosis Group (APPTG) has conducted an audit on the uptake of the Chief Medical Officer's (CMO) recommendations on the prevention of venous thromboembolism (VTE) in hospitalised patients published in April 2007, and the NICE guidance. This audit will form part of a report to Parliament

- In April 2007, NICE published guidelines that aim to reduce the risk of thromboembolism after surgery. They recommend that all surgical patients undergo a risk assessment on admission, and are prescribed pharmacological or mechanical thromboprophylaxis accordingly. In addition they advise on other aspects of patient care and medical practice that may reduce the risk of VTE 9

- The report to the CMO (the Independent working group report), also published in April 2007, summarises existing recommendations and guidelines for the prevention of VTE in hospitalised patients. The purpose of the report is to advise how current best practice can be promoted and implemented. The CMO's report came almost 18 months after the House of Commons Select Committee published a Report into VTE10

* Based on 2005 figures for MRSA and Clostridium difficile
** Based on Global data for hospitalised patients
** Total direct and indirect costs include direct medical costs (e.g. medication, costs of procedures etc) and indirect costs (loss of productivity, burden on society etc)

References

1. All-Party Parliamentary Thrombosis Group (APPTG) VTE Research Report, April 19 2007 (based on 27,000 diagnosed - assume preventable - deaths per year from PE2, 7 months since publication of CMO recommendations, 68% of Trusts not implementing. 15,750 x 68% = 10,710)

2. House of Commons Health Committee. The Prevention of Thromboembolism in Hospitalised Patients, Second report of session 2004-2005. Available here downloaded 29 June 2006 (Incidence 59,000 DVT, 27,000 diagnosed - assume preventable - PE. 27,000/59,000 =46%)

3. National Office of Statistics. Available here (2,083 and 3,807 deaths associated with MRSA and Clostridium difficile respectively in 2005, in 7 months may equate to approx 3,436 deaths. 10,710/3436 = 3.1)

4. NICE Costing Report. Available here.

5. Department of Health 2007. Available here.

6. Sandler DA. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med 1989; 82:203-205.

7. Cohen AT et al. A large-scale, global observational study of venous thromboembolism risk and prophylaxis in the acute hospital care setting: the ENDORSE study. Abstract N° 1827, presented at the XXIst Congress of the International Society on Thrombosis and Haemostasis, Geneva, 8 July 2007

8. Task Force Report: Guidelines on diagnosis and management of acute pulmonary embolism. Torbicki, EJR, et al. Eur Heart Journal 2000; 21, 1301-1336.

9. NICE guidelines on VTE: reducing the risk of VTE (DVT and PE) in inpatients undergoing surgery. Available at: http://www.nice.org.uk/nicemedia/pdf/VTEFullGuide.pdf

10. Report of the Independent Expert Working Group on the prevention of VTE in hospitalized patients. Available at: here.

Huntsworth Health