Summary
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.
Challenge
The nurse-led Thrombosis Clinic at UH Bristol was set up in 2006 to manage the investigation and outpatient treatment of patients with a suspected DVT.
Prior to the development of the care pathway for adult patients with suspected DVT, all patients were assessed in the emergency department (ED), where they had to wait until a vascular scientist was available to perform a duplex scan.
If this confirmed a DVT, patients were discharged with outreach support or admitted under the care of the medical on take team. They then remained in hospital until their INR was stabilised.
This caused delays and possibility of breaches in the emergency department, along with unnecessary inpatient stays which were costly financially, physiologically and socially.
Objectives
The clinic is based in the Ambulatory Care Unit at the Bristol Royal Infirmary, operating seven days a week.
Patients are offered an appointment on the day of referral or within 24 hours if the referral is made late in the afternoon. Although no duplex scanning is available at the weekend, the clinic can assess patients and administer low molecular weight heparin. The nurses can also provide investigation and treatment for patients with a suspected pulmonary embolism (PE).
The overall aim of the service is to assess, investigate and treat patients in an outpatient setting, in as efficient a way as possible (to allow more patients to be seen) whilst providing expert, specialist care at all times.
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