Leading Innovation in Anticoagulation: a practical team approach


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.


In 2012 a number of ambulatory care pathways were introduced to help reduce in-patient beds.  Rivaroxaban was introduced in 2013, to address the the need for frequent blood sampling and hospital visits.

The development of a review clinic (virtual ward) has allowed exploration of the connection between unprovoked VTE and underlying malignancy, offering patients timely investigations, an earlier diagnosis and treatment.

The absence of national training standards prompted the team to develop a robust training plan.

The establishment of the Trust thrombosis network and Kent Thrombosis Network  (pending) will improve communication, and encompass the focus of VTE prevention through to diagnosis and long-term management.


Key objectives included the transferral of DVT services from A & E to ambulatory care, providing a clear management pathway focused on quality standards and patient choice, and implementing Rivaroxaban in accordance with NICE recommendations.

The project also aimed to provide a follow-up virtual clinic for practitioners to discuss patients and their treatment, to maintain and strengthen a patient-focused multidisciplinary collaborative approach, and to work with stakeholders, including partients, to produce patient-friendly materials.

Further objectives included the development of a central DVT training facility, engaging with patients to gather feedback, and helping community services develop a community-based DVT clinic. The final objective was to work with the National Nursing and Midwifery Network to facilitate a Kent Thrombosis Network.

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QiC Anticoagulation Winner 2014
Best Hospital Team of the Year
Leading Innovation in Anticoagulation: a practical team approach
by East Kent Hospitals University Foundation Trust


Lucy Harling

Job title:
DVT/Ambulatory care sister and lead DVT nurse
Place of work:
East Kent Hospital University Foundation Trust
01227 783170


DVT Clinic - 968.5 KB