NICE: trusts must offer DVT tests within 24 hours
Hospitals have been set “challenging” new clinical targets to provide a “seven-days-a-week” service for patients presenting with a suspected venous thromboembolism.
Trusts should provide patients with suspected deep vein thrombosis an ultrasound scan within four hours of presentation, if possible, according to the National Institute for Health and Clinical Excellence.
NICE this week published its first ever guidance on the diagnosis and treatment of VTE, including DVT and pulmonary embolism.
It said, at the very least, patients with suspected DVT should not have to wait more than 24 hours for an ultrasound, while patients with suspected PE should be offered a CT scan immediately, or as soon as possible.
Gerrard Stansby, professor of vascular surgery and guideline development group chair, warned there was currently “variable practice” in how patients were investigated for VTE.
He said: “We don’t want to put people on anticoagulants unnecessarily and we don’t want to miss cases.
“In the modern era, it is appropriate for patients to be able to get these tests seven-days-a -week and not be restricted to weekday working.
“It should not be the case that if you come in Friday you have to wait till Monday for diagnostic tests, not for such potentially fatal conditions.”
However, he acknowledged it would be a “challenge” for some trusts to provide the tests within NICE’s recommended timeline. These would be issues of “staffing” and “logistics”, rather than lack of equipment, he told HSJ.
“The tests themselves are not new tests, they are in all the hospitals already. It’s simply providing them out of hours and at weekends,” he said.
In addition, NICE recommended patients over 40 who presented with VTE without an obvious cause, such as having undergone surgery, should also undergo investigations for cancer due to evidence of a link between the two conditions.
Professor Stansby added: “Cancer may be the reason why a patient develops one of these blood clots in the first place.”
He predicted there would “almost certainly” be a NICE quality standard developed that would “mirror the most important features of the guideline” in order to guide commissioning.
The document follows a warning in July last year from NHS medical director Sir Bruce Keogh that hospitals where patients died unnecessarily from DVT would be “named and shamed”. He said it was “absolutely disgraceful” that some 25,000 patients died every year after developing DVT.
A Commissioning for Quality and Innovation payment goal was introduced the previous year for “reducing avoidable death, disability and chronic ill health from VTE”.