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Fatal venous thromboembolism associated with hospital admission: a cohort study to assess the impact of a national risk assessment target
  1. Will Lester1,2,
  2. Nick Freemantle1,3,
  3. Irena Begaj1,
  4. Daniel Ray1,
  5. John Wood3,
  6. Domenico Pagano1,2
  1. 1Quality and Outcomes Research Unit, University Hospital Birmingham, Birmingham, UK
  2. 2School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
  3. 3Department of Primary Care & Population Health, University College London, London, UK
  1. Correspondence to Professor Domenico Pagano, Department of Cardiothoracic Surgery, University Hospital Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK; domenicopagano{at}me.com

Abstract

Objectives In 2010, the Department of Health in England introduced an incentivised national target for National Health Service (NHS) hospitals aiming to increase the number of patients assessed for the risk of developing venous thromboembolism (VTE) associated with hospital admission. We assessed the impact of this initiative on VTE mortality and subsequent readmission with non-fatal VTE.

Design Observational cohort study.

Patients All patients admitted to NHS hospitals in England between July 2010 and March 2012.

Interventions An NHS hospital which assessed at least 90% of patient admissions achieved the quality standard.

Main outcome measures The principal outcome measured was death from VTE up till 90 days after hospital discharge using linked Office of National Statistics and Hospital Episode Statistics data.

Results In the principal analyses of patients admitted to hospital for more than 3 days, there was a statistically significant reduction in VTE deaths in hospitals achieving 90% VTE risk assessment: relative risk (RR) 0.85 (95% CI 0.75 to 0.96; p=0.011) for VTE as the primary cause of death. In supportive analyses of postdischarge deaths after index admissions of up to 3 days, there was also a reduction in fatal VTE RR 0.61 (0.48 to 0.79; p=0.0002). This effect was seen for both surgical and non-surgical patients. No effect was seen in day case admissions. There was no change in non-fatal VTE readmissions up to 90 days after discharge.

Conclusions A national quality initiative to increase the number of hospitalised patients assessed for risk of VTE has resulted in a reduction in VTE mortality.

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