• VTE detected in between 20 and 42 per cent of patients in hospital who have had a stroke
  • HSIB warns “there is no proactive, stroke-specific, VTE risk management programme to monitor risk assessments”

Tens of thousands of NHS stroke patients could be at risk of suffering fatal blood clots while recovering in hospital because of failures to assess their risk and act on care plans, the NHS has been warned.

The Healthcare Safety Investigation Branch has issued an interim bulletin as part of its national investigation into the management of venous thromboembolism, or VTE, in patients who have suffered a stroke.

Investigators said they had identified a safety issue which “impacts all specialist stroke units and other wards where stroke recovery is managed in the NHS”, adding that VTE was detected in between 20 and 42 per cent of patients in hospital who have had a stroke.

Every year, more than 100,000 people have a stroke, with 95 per cent admitted to hospital.

HSIB said: “There is no proactive, stroke-specific, VTE risk management programme to monitor risk assessments and no check that the risk assessment requirements and recommendations have been undertaken.

“Despite national guidelines being in place relating to the management of VTE in patients that have suffered a stroke, incidents of harm continue to occur. For example, intermittent pneumatic compression (IPC) is an effective method of reducing the risk of VTE and improving survival in patients who are immobile after stroke but can fail to be applied.”

In May last year, HSJ reported fears for safety over falling rates of VTE risk assessment in NHS hospitals which meant thousands of inpatients were at risk of deadly clots.

The latest performance data published by NHS Improvement shows that, while the NHS nationally is achieving the target of 95 per cent of patients being risk assessed, more than a quarter of NHS providers are below the target level. Three providers are below 90 per cent.

HSIB’s bulletin was released after it launched an inquiry into the treatment of a 78-year-old woman who had suffered a stroke at home and was treated in hospital on a hyper acute stroke unit. She was given thrombolysis, or drugs to break down the clot causing the stroke, and was recorded as being at high risk of a VTE.

An IPC device that surrounds the legs and inflates with air was considered and a box on the VTE form was ticked but was not fitted and a subsequent VTE risk assessment after 24 hours was not carried out.

Fourteen days after admission, the patient was found slumped over a table and later developed breathlessness. A pulmonary embolism was suspected and diagnosed two days later. The patient was discharged home after being cared for on a high dependency unit and stroke ward a month later.

HSIB will continue its investigation before publishing a full report which could include safety recommendations for national bodies to act on.