The NHS’s defence organisation, NHS Resolution, has published a ‘Did You Know’ factsheet about venous thromboembolism or VTE. The fact sheet provides a reminder for NHS staff and organisations about the risks, signs and symptoms, and recommended investigations and treatment for venous thromboembolism, based on common themes from 687 VTE negligence claims. What is venous thromboembolism (VTE)? Venous thromboembolism is a serious condition that occurs when a blood clot fully or partially blocks the flow of blood through a vein. The most common types of VTE are deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs when a blood clot forms in a deep vein, often in the lower leg. Missed or delayed diagnosis of DVT or failure to treat the condition can result in the patient suffering a PE, which can cause the patient’s death. PE occurs when a blood clot partly or completely blocks one or more of the arteries of the lung. Pulmonary embolism is often caused by clots which have travelled through the bloodstream from somewhere else in the body, such as a DVT in the leg. Missed or delayed diagnosis and treatment of PE can result in permanent disability from cardiac arrest or heart failure, damage to the lungs from pulmonary infarction, or can lead to fatal injury (death). How common is venous thromboembolism (VTE)? One in 20 people will have a VTE at some time in their life. An individual’s risk of VTE increases as they get older, during pregnancy and with various lifestyle factors and medications. However, people are most at risk of developing blood clots leading to venous thromboembolism after major injury (trauma), major surgery and being immobile for long periods of time after hospitalisation. Around half of all VTEs are associated with being in hospital for major illness or surgery. Venous thromboembolism, such as DVT or pulmonary embolism, is recognised as a significant cause of death, disability and long-term health problems. MBRRACE-UK’s most recent report on maternal mortality revealed that VTE is the most common cause of maternal death during pregnancy, labour and birth, and the first few weeks postnatally. Doctors and other healthcare clinicians need to be alert to the dangers of VTE conditions, such as DVT and PE, in their patients but must also understand that with correct and timely risk assessment, investigation, diagnosis and treatment, lasting injury from VTE is often avoidable. In fact, VTE charity, Thrombosis UK, states that VTE is the number one cause of preventable deaths in hospitals. Recognising signs and symptoms and making a diagnosis NHS Resolution’s venous thromboembolism factsheet reminds clinicians that symptoms of DVT in the leg include: • Throbbing or cramping pain (most often in just one leg), usually in the calf or thigh; • Swelling (usually in just one leg); • The skin around the painful area is warm, red or darkened; • Swollen veins that feel hard or sore to touch. Symptoms of pulmonary embolism or PE include: • Pain in the chest or upper back; • Shortness of breath; • Dry cough; • Coughing up blood, or haemoptysis; • Rapid heart rate. Timely diagnosis also requires awareness and thorough investigation, as DVT can sometimes present with only mild symptoms, and pulmonary embolism can occur without any previous symptoms of DVT. This means that it is vitally important for doctors to listen to and consider their patients’ concerns before and whilst examining them. They must ask relevant questions to find out whether the patient has risk factors for VTE, such as whether the patient has recently been immobilised as a result of a fracture, surgery or illness, and whether they or their family have previously suffered from venous thrombosis or VTE. After a comprehensive history and clinical examination has taken place, diagnostic tools such as the Wells score, D-dimer test and ultrasound imaging are recommended to help reach a diagnosis. NHS Resolution reminds clinicians that NICE provides national guidance to help reduce the risk of VTE and which describes high-quality care in priority areas for improvement. NICE guidance also mandates that patients should be individually risk assessed for VTE on admission to hospital and reassessed whenever their clinical situation changes. What are common causes of medical negligence claims involving venous thromboembolism or VTE? NHS Resolution analysed 687 past VTE injury claims that it had received as clinical negligence indemnity insurer for NHS trusts and GPs. 60% or 411 of these claims were settled with compensation payments which totalled £23,780,179. Increased risks from DVT and PE occurred in surgical specialties, especially major orthopaedic surgery and where operating time and immobilisation after the operation is longer. Other risk factors included older age or previous history of VTE, or where the patient was admitted to hospital with acute medical illness, particularly when combined with immobility. Previous thematic reviews of high value and fatal negligence claims have also shown that VTE is one of the most common causes of death arising from missed diagnosis in A&E or ED. Venous thromboembolism is also a common theme in medical negligence claims against GPs. NHS Resolution identified that the most common causes of VTE negligence claims were: 1. Treatment delays or failure to treat; 2. Failure or delay in making a diagnosis; 3. Medication errors, such as failure to risk assess, or prescribe, administer or give the correct dose of anticoagulant; 4. Inappropriate treatment; 5. Failing to recognise complications; 6. Failing to perform tests; 7. Failing to carry out a pre-operative evaluation; 8. Poor nursing care; 9. Failing to follow up the patient; 10. Discharging the patient inappropriately. We welcome NHS Resolution’s reminder to healthcare organisations and clinicians of the importance of understanding and assessing each patient’s risk of venous thrombosis (blood clots) and thromboembolism (VTE). Delays in diagnosis or treatment of deep vein thrombosis and pulmonary embolism can cause death or life-changing disability from conditions which are often treatable or preventable with correct care. Where a patient or pregnant mother suffers severe injury or death from negligent risk assessment or management of VTE, they or their bereaved family may be entitled to compensation. If you or someone in your family have suffered serious injury as a result of medical negligence, or have been contacted by HSIB/HSSIB, CQC or NHS Resolution, you can talk to an experienced solicitor, free and confidentially, for advice on how to respond or make a claim by contacting us.
