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

1. The role of VTE exemplar centres:the King’s College Hospital experience Dr Roopen Arya King’s College Hospital NHS Foundation Trust 2008

2. 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

3. 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

4. Thrombosis committee: • Anticoagulation / thrombosis committee • Established 1999, quarterly meetings • Multidisciplinary group • Instrument for clinical governance & enabling change

5. 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

6. 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

7. 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

8. Integrated Care Pathway for DVT

9. 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

10. 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

11. ‘Seamless’ care A & E Wards Primary Care DVT CLINIC Promoting VTE prevention ANTICOAGULATION CLINIC THROMBOPHILIA CLINIC

12. Education • Senior and junior doctors • Nurses • Pharmacists • Trust Management • Trust risk management & other committees • Patients

13. Clinical audit • Risk assessment • Uptake medical thromboprophylaxis • Uptake surgical thromboprophylaxis • Compliance with local guidelines – appropriate thromboprophylaxis • Counselling of patients re: risk • Outcome measures