| Each year over 25,000 people in England die from venous thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than twenty-five times the number who die from MRSA. The figures are alarmingly high. Even more alarming is the fact that many of these deaths are preventable. There is a safe, efficacious and cost effective method of preventing venous thrombosis which is not being as widely administered as it should be.
There are various reasons for this situation. Witnesses told us that many physicians and surgeons were not aware of the extent of VTE. A substantial number of patients who develop VTE first show signs that they have the disease after they have been discharged from hospital. As a result the original physician or surgeon who treated the patient in hospital is often not informed that their patient suffered from the condition after leaving their care. Moreover, there are no national guidelines which would ensure that doctors consider the risk of VTE and the availability of prophylaxis.
The Department of Health has now commissioned the National Institute of Clinical Excellence to produce a set of guidelines for the administration of preventative measures which are expected to be published in May 2007. This is a remarkably tardy response to a serious situation and, moreover, the scope of the guidelines commissioned by the Department is limited to a subset of surgical patients, while the majority of sufferers are non-surgical patients. In contrast, in the United States the American College of Chest Physicians has recently published the 7th revision of their guidelines which were first produced in 1986. Based upon the effectiveness of the intervention and the cost-effectiveness of applying that intervention, routine thromboprophylaxis for appropriate potential groups in hospital was ranked the number one most important safety practice in that country by the US Health Agency for Research and Quality.
We recommend that the NICE VTE guidelines be extended in scope to cover the majority of hospital patients. We further recommend that on admission to hospital all patients, both medical and surgical, be counselled about the risks of VTE and undergo a risk assessment to determine if prophylaxis, to help prevent the onset of venous thrombosis, should be administered. To raise awareness among medical practitioners of the extent of the problem we recommend that all physicians and surgeons are informed if their patients contract VTE after they have been discharged from hospital.
During the inquiry we heard serious doubts as to the extent to which the guidelines will be implemented when they finally become available. This is a recurring problem which the Committee has come across in several inquiries. Accordingly, our report makes recommendations to ensure their effective implementation. The Department, NICE and the Royal Colleges should work together to raise awareness of the extent of VTE and to audit the use of the guidelines. Our most important recommendation is that thrombosis committees and thrombosis teams should be established in each hospital to promote best practice now, using accepted guidelines adapted for local practice, and to be a source of education and training for all staff dealing with patients at risk of VTE. When NICE guidelines are published the committees and teams will be in place to ensure adherence. They should be modelled on the effective teams and committees dedicated to improving the use of blood transfusion. Finally we recommend that the Healthcare Commission audit the availability and use of venous thrombosis prophylaxis in hospitals.
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