Quality Standards
Issued: March 2013
QS29

Quality standard for diagnosis and management of venous thromboembolic diseases

Introduction and overview

Introduction

Venous thromboembolism (VTE) is a condition in which a blood clot (a thrombus) forms in a vein, most commonly in the deep veins of the legs or pelvis. This is known as deep vein thrombosis, or DVT. The thrombus can dislodge and travel in the blood, particularly to the pulmonary arteries. This is known as pulmonary embolism, or PE. The term VTE includes both DVT and PE.

VTE is an important cause of death and its prevention and management is a priority for the NHS. It has been estimated that 25,000 people in the UK die every year from preventable hospital-acquired VTE[1]. Non-fatal VTE is also important because it can cause serious longer-term conditions such as post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension.

The diagnosis of VTE is not always straightforward because other conditions have similar symptoms. Failure to diagnose a case of VTE may result in a patient not receiving the correct treatment and potentially developing post-thrombotic syndrome or a fatal PE as a result.

This quality standard covers the diagnosis and treatment of venous thromboembolic diseases in adults, excluding pregnant women. For more information see the scope for this quality standard. For prevention of VTE see the NICE quality standard for the prevention of VTE.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. The quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following framework:

The table below shows the outcomes, overarching indicators and improvement areas from the framework that the quality standard could contribute to achieving:

NHS outcomes framework 2013–14

Domain 1: Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

Domain 3: Helping people to recover from episodes of ill health or following injury

Overarching indicator

3a Emergency admissions for acute conditions that should not usually require hospital admission

3bEmergency readmissions within 30 days of discharge from hospital* (PHOF 4.11)

Domain 5: Treating and caring for people in a safe environment; and protecting them from avoidable harm

Overarching indicators

5bSafety incidents involving severe harm or death

Improvement areas

Reducing the incidence of avoidable harm

5.1Incidence of hospital-related venous thromboembolism (VTE)

Overview

The quality standard for Diagnosis and management of venous thromboembolic diseases states that services should be commissioned from and coordinated across all relevant agencies encompassing the management of venous thromboembolic diseases care pathway. A person-centred approach to provision of services is fundamental to delivering high quality care to adults with venous thromboembolic diseases.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should cross refer across the library of NICE quality standards when designing high-quality services.

Patients, service users and carers may use the quality standard to find out about the quality of care they should expect to receive; support asking questions about the care they receive; and to make a choice between providers of social care services.

The quality standard should be read in the context of national and local guidelines on training and competencies. All health and social care professionals involved in assessing, caring for and treating adults with venous thromboembolic diseases (including those who assess remotely using algorithms written by medical professionals) should be sufficiently and appropriately trained and competent to deliver the actions and interventions described in the quality standard.