Leading Innovation in Anticoagulation: a practical team approach
by East Kent Hospitals University Foundation Trust
A reconfiguration of the Trust's services in 2012 meant the introduction of ambulatory care pathways, including DVT and PE pathways. Staff developed a nurse-led multidisciplinary team approach to out-patient care for the assessment, diagnosis, treatment and follow-up care of DVT and PE. Following the publication of NICE guidelines for venous thromboembolism the team identified areas of improvement, leading to the introduction of strategies for anticoagulant therapy choices, a virtual follow-up clinic and the development of information and educational resources. The team has successfully developed a one stop integrated DVT service that has reduced patient waiting times and ensured consistency and continuity of patient care.
"This team has excellent long-term vision. The work is commendably inclusive, with lots of patient involvement and the service provided stretches across numerous hospitals and far out into the community."
Oxford One-Stop DVT Diagnostic Clinic
by Oxford University Hospitals NHS Trust
The Oxford thrombosis service houses an out-patient DVT diagnostic service which has been running since 2000. In 2012, the DVT team led an initiative for a 'one-stop' diagnostic DVT service, raising money to secure an intra-departmental ultrasound scanning machine. With the direct involvement and support of the radiology department, the existing patient pathway for DVT diagnosis was adapted so that all patients undergoing assessment for DVT were offered same day compression ultrasound within the DVT department. The main outcomes that the team has been able to improve are patient satisfaction and diagnostic waiting times.
"This is the perfect service for GP referral. A very professional team, working in a highly effective way to produce outstanding, well measured results. The service is cost effective and patient experience is measured robustly."
Development of a new pathway to include the use of rivaroxaban
by University Hospitals Bristol NHS Foundation Trust
The nurse-led thrombosis clinic at UH Bristol was set up in 2006 to manage the investigation and treatment of patients with a suspected DVT. The clinic now operates seven days a week and is based in the ambulatory care unit at the Bristol Royal Infirmary. Patients are offered an appointment on the day of referral to the service or within 24 hours if the referral is made late in the afternoon. The number of patients now seen by this new service has increased dramatically, from 1,000 in 2008 to over 3,500 in 2013. By implementing rivaroxaban and reducing the workload on the team, the service has been able to evolve – increasing patient numbers, while also expanding the service without increasing staff numbers.
"This team is embracing thrombosis in all its forms, and the non-silo-based approach from diagnosis to treatment is good. The collaboration demonstrated both with other teams within the hospital and with industry was excellent."