Researchers urge hospital doctors to routinely assess blood clot risks in emergency medical admissions

Introducing a simple risk assessment tool could increase the number of patients receiving vital medication for dangerous blood clots, according to a paper just published online by IJCP, the International Journal of Clinical Practice.

Venous thromboembolisms (VTEs) kill more than 25,000 people in the UK every year according to a report released by the Commons Health Committee earlier this month. But a multi-disciplinary team of NHS researchers from Sherwood Forest Hospitals NHS Trust, Nottinghamshire, has shown that introducing a simple risk assessment form reduced the number of emergency medical admissions not receiving medication for VTEs by two-thirds.

The team, led by Dr George Thomson, carried out four audits between 2000 and 2004 on a total of 485 patients. These measured how many risk assessment forms were completed and identified how many patients did not receive VTE medication when it was clinically indicated. The number of forms completed rose from 34 per cent to 49 per cent over the four-year period and the percentage of patients not receiving VTE medication fell from 29 per cent to 10 per cent.

A further survey of 21 doctors working for the Trust broadly reflected the 49 per cent completion rate, with 57 per cent saying they completed forms usually, most of the time or always and 43 per cent saying they rarely completed them. The most common reasons for not completing the form were that they did not remember (48 per cent), that they followed their own instincts about which patients needed medication (33 per cent) and lack of time (24 per cent). “Our research shows that there is a pressing need to use risk assessment forms for all emergency medical admissions so that doctors can prescribe medication to combat potentially fatal blood clots” says Dr Sooriakumaran, the paper’s lead author.

“We have shown that doctors appear to know what to do when it comes to possible VTEs, but still do not always do it. The commonest reason is that they simply forget. “It may also be that doctors who are working in an acute hospital setting, where potentially life threatening emergencies are being treated, do not place VTE assessments high on their list of priorities. “It should be pointed out that compliance with the procedures are much better for surgical patients than medical patients.”

The risk assessment tool was introduced by the Trust in 1998 after an audit demonstrated poor adherence to the recommendations made by the Thromboembolic Risk Factors Consensus Group in 1992. A multi-disciplinary group devised a simple risk assessment tool, based on the recommendations, for use in all emergency admissions. The tool was made available in all ward areas and clinical staff trained in its use. The risk assessment form was subsequently incorporated into the standard admission documentation pack for all emergency medical admissions. It asks clinicians to assess the patients on 18 grounds, with points of one to four awarded for each category.

The form specifies that any patients scoring five or more points should receive medication, with a higher doses for patients scoring seven points or more. “Incorporating this standard procedure into hospital admissions is essential” concludes Dr Sooriakumaran, who is now at Royal Surrey County Hospital. “Our audits show that risk assessment forms like these are a highly successful tool in combating potentially fatal VTEs.” “Our study shows a continual improvement in our performance and this is undoubtedly based on the various measures we have implemented as a result of our repeated audits” adds Dr George Thomson from Sherwood Forest Hospitals NHS Trust. “However we are not complacent and we realise that there is still scope for further improvement.

“The Trust has implemented rigorous education programmes for our medical and non-medical staff but this alone has not proved wholly effective as the audit results show. “We are now looking at how we can use other measures to improve our VTE medication rates and any policy changes will be monitored by further audits.”