The role of VTE exemplar centres:the King’s College Hospital experience

Dr Roopen AryaKing’s College Hospital NHS Foundation Trust

2008

VTE Exemplar Centres

Resource for demonstration of best practice Based within hospitals or networks with an existing

track record of excellent VTE management Expanded role including quality control, audit and

education Help develop national risk assessment strategy,

audit tools, centralised educational material to support local programmes

King’s College Hospital is first NHS exemplar centre & the London Clinic in the independent sector

Plan to develop network of exemplar centres

VTE Exemplar Centres

Chief Executive agreement / support Mechanism in place for VTE risk assessment Audit trail – evidence of prevention

management across organisation Education and raising awareness re: VTE Multidisciplinary team approach Ability to act as a resource to spread good

practice

Anticoagulation / thrombosis committee

Established 1999,quarterly meetings

Multidisciplinary group

Instrument for clinical governance & enabling change

Thrombosis committee:

Agenda items

Setting up a thrombosis team DVT and PE care pathways Anticoagulant drugs Thromboprophylaxis for surgical patients Thromboprophylaxis for medical patients Audit Adverse incidents

Achievements

Establishment of clinical thrombosis services Policies for thromboprophylaxis and treatment

of VTE Policies regarding anticoagulation Trustwide consensus & clinical guidelines Promote clinical research Resource for education and training Vital part of the Trust framework for clinical

governance & audit

King’s Clinical Thrombosis Service

• Dedicated multidisciplinary service

• Best practice / evidence-based treatment

• Minimise delays & reduce hospital admissions

• Provide a cost-effective service

• Improve quality of care

Integrated Care Pathway for DVT

King’s Clinical Thrombosis Service

Cared for >4000 patients with suspected DVT

age range 16 yrs to 101 yrs

25% treated for DVT, 90% treated at home

Outpatient management safe & effective

Improved care: flexible patient-focused service

King’s Clinical Thrombosis Service

Reduced admissions, bed days saved Close links with Primary Care: 73% patients direct

referrals from GPs; reduced presentations to A & E Short waiting times: diagnosis within 2 hrs,

treated within 4 hrs Patient satisfaction & empowerment

Lessons from DVT care applied to care of patients

with pulmonary embolism

DVT CLINICDVT CLINIC

ANTICOAGULATION ANTICOAGULATION CLINICCLINIC

THROMBOPHILIA THROMBOPHILIA CLINICCLINIC

Primary CarePrimary Care WardsWardsA & EA & E

‘Seamless’ care

PromotingVTE prevention

Education

Senior and junior doctors

Nurses

Pharmacists

Trust Management

Trust risk management & other committees

Patients

Clinical audit

Risk assessment Uptake medical thromboprophylaxis Uptake surgical thromboprophylaxis Compliance with local guidelines –

appropriate thromboprophylaxis Counselling of patients re: risk Outcome measures