Hospital trusts failing to check inpatients' risk of deadly clots

Fifty-nine per cent of the 51 trusts that responded to an HSJ Freedom of Information inquiry are not yet doing documented risk assessments across all inpatients for venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism.

This is despite a letter from chief medical officer Sir Liam Donaldson to all health professionals last year highlighting advice from the independent expert working group on the prevention of VTE.

Triggers include having an operation or being immobilised in bed. A 2005 health select committee report said 25,000 people died from VTE contracted in hospitals each year.

Public health minister Dawn Primarolo told HSJ: "There isn’t any excuse for not doing [risk assessments] – they are very straightforward, simple, basic steps."

In response to HSJ's Freedom of Information request, most trusts said they conducted some form of assessment in certain areas, but only 29 per cent confirmed they were doing checks for all inpatients. Trusts cited difficulties getting all staff to carry out risk assessments, delays in implementing the recommendations and disputes over guidance in particular clinical areas among reasons for not checking every patient for risk of VTE.

In his introduction to the independent expert working group's report, Sir Liam charged an implementation group with developing a national risk assessment tool. The report also said the Healthcare Commission would deliver an audit strategy for VTE. Neither of these has yet been delivered.

NHS Confederation policy director Nigel Edwards said: "Despite the expert report, and the NICE guidance [on assessing VTE risk in surgical admissions] that was issued, the Healthcare Commission doesn’t seem to have picked this up in the way mentioned and the Department of Health hasn’t issued the framework. This illustrates the danger of focusing everyone on targets."

Dr Simon Noble, medical director of thrombosis charity Lifeblood, said that a mandatory risk assessment was an easy step that could save thousands of lives. "This is nothing short of a public health emergency," he said. "We're looking at a preventable event that kills more people annually than MRSA, breast cancer and HIV put together." He warned that if a patient died who had not been risk assessed, and who would have been put on medication as a result of a risk assessment, it would be "very hard" for a trust to defend itself.

Dr Noble said medics needed to do a simple tick-box risk assessment and prescribe stockings or a short course of a blood-thinning drug where appropriate. But he added: "People respond to targets because they have to. We need to say that mandatory risk assessment needs to occur and it needs to be auditable."

Labour MP Des Turner, secretary of the all-party parliamentary thrombosis group, said that the level of awareness of the recommendations among hospital staff seemed "distressingly variable".

A DH spokesperson said the chief medical officer had acknowledged in his forward to the expert working group report that more data was needed and that there was no systematic approach to identifying and treating patients at risk from VTE in hospitals.

"The implementation working group that was set up after the report was published is considering what needs to be done to make a VTE risk assessment of all hospitalised patients a reality," he said. "The Healthcare Commission is also considering how they might assist in monitoring trusts’ progress in this area."

Key facts

25,000 - The number of people who die from venous thromboembolism contracted in hospital each year

£64m - The annual cost to the NHS of managing VTE cases

30% - The mortality rate for VTE

2%-8% - The mortality rate if the patient receives appropriate therapy

£18.9m - The amount paid out by the NHS in clinical negligence compensation and defence costs where VTE or related conditions were cited in the 10 years to 2006-07

Sources: health select committee, thrombosis charity Lifeblood, Hansard