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Warning over lack of VTE assessment in A&E patients

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Almost three quarters of patients who are treated for lower limb injuries and put into plaster casts in accident and emergency departments are not being risk assessed for venous thromboembolism (VTE) before being discharged, an audit has revealed.

This is despite this type of treatment putting them at significant risk of the developing the condition, said the Royal College of Emergency Medicine, which carried out the audit.

“VTE prophylaxis should not rely on individual clinicians remembering to perform this. There must be a safe system that ensures patients are treated appropriately”

RCEM report 

The analysis of 9,916 adults presenting to 167 UK emergency departments, found only around 26% of patients had a formal VTE assessment recorded in A&E.

The RCEM recommends there should be written evidence of the patient receiving or being referred for treatment for VTE, and that there was evidence that a patient has been provided with an information leaflet on the condition.

However, the audit also revealed that 70% of patient notes did not include an indication about whether treatment was needed.

In addition, on being discharged, only 13% of patients were given an information leaflet outlining the risk and the need to seek medical attention if they developed symptoms of VTE.

The RCEM called for more action by A&E departments to minimise the risk of VTE in its report, called VTE Clinical Audit 2015-16.

“This additional work [of reducing harm to patients] incurs a cost in clinical time, and this must be recognised by the necessary resource allocation”

Cliff Mann

Its recommendations included that clinicians ensure risk assessments were done with outcomes and the need for treatment clearly documented, along with evidence that patients had been provided with information leaflets on VTE.

“VTE prophylaxis should not rely on individual clinicians remembering to perform this. There must be a safe system that ensures that these patients are reliably identified and treated appropriately. This is particularly true in the environment of an ED,” said the report.

RCEM president Dr Cliff Mann said: “In the course of the last 30 years, we have seen venous thromboembolism evolve from being a ‘silent killer’, largely the product of misfortune, to recognition that our own actions can both promote and diminish the risk substantially.

CEM

Dr Clifford Mann

Clifford Mann

“Reducing harms to patients before they occur, rather than reacting to consequential emergencies – in this case pulmonary embolus - is an excellent example of pro-active emergency care,” he said.

“Embedding such best practice into the patient’s emergency care pathway is a powerful marker of quality that we strongly recommend,” said Dr Mann.

“This additional work incurs a cost in clinical time, and this must be recognised by the necessary resource allocation,” he added.

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