Balmoral building level 1 between ED and radiology and the WRVS cafe What use is the DAWN VTE module? UHL acute ambulatory DVT service – where are we now? M-F 8am-8pm (6:30pm last referral) Sat 8am-12am(10:30am last referral) jane.strong@uhl-tr.nhs.uk
Approach and principles moving forward DVT/PE/Anticoagulation Service – One Service – One Team • Stakeholder •Goals Service Vision Service Vision • Public • Patient •No Serious Incidents •Correct Diagnosis and Treatment first time •Prevention •Best Patient Experience Best Best Improving Improving Possible Possible Health Health Care Care Step opportunity for improvement Joy and Joy and Value for Value for Pride in Pride in Money Money Work Work • Commissioning Group • Team •Reduce Cost •Clear Understanding of Process, Role and •No Waste Responsibilities
DVT Service – One Service – One Team Low Blood Blood Test Test Unlikely High Wells Wells -ve Score Score 2 weeks Likely To 3 Prescribe Prescribe Months Scan Scan Assess Assess +ve Inject Inject Level 1 Level 2 Level 3 85% 20% NICE CG144/TA261/TA327/TA341
The recent wins The recent wins The recent wins The recent wins • Rivaroxaban • Doubling our ultrasound scan provision from 40 to 80 slots per week • Active development of a paperless system
The recent wins The recent wins The recent wins The recent wins • Rivaroxaban • Doubling our ultrasound scan provision from 40 to 80 slots per week • Active development of a paperless system
Active development of a paperless DVT module • Seamless referral and GP communication • Improved clinical Design a governance and DVT module audit trail • A WIN-WIN-WIN
An electronic tool and record for deep vein thrombosis (DVT) assessment, diagnosis, treatment and follow up. J Strong, V Frimpong, J Eggleston, D Thornton, H Briggs, T Stewart, R Clarke-Drury, K Coultas, A Stewart, G Kitching, S Stewart Background: University Hospitals of Leicester acute ambulatory DVT service assesses 3,000 patients a year and treats 600 new DVTs. Service improvements were required to optimise administrative processes. Our paper-based system was inappropriately diverting our DVT nursing team from delivering a very busy clinical service and making audit difficult. Aims: We wanted to create an electronic DVT record within the same system as the computer aided anticoagulant dosing software. The vision of a paperless DVT module (assessment, diagnosis, treatment and follow up) with seamless referrals and communication with anticoagulation and primary care was born . Methods: The whole DVT pathway has been sequentially computerised and tested within the clinical environment. Results: The module first went live in August 2013.Between August 2013 and December 2014 we have assessed 4248 patients using the module; 675 (16%) were assessed as DVT unlikely with Wells score and d dimers and did not proceed to scan, 3426 had scans of which 754 DVTs (22%) and 147 cases of thrombophlebitis were diagnosed. Rivaroxaban became first line treatment for first DVTs in our service in October 2014 – a rivaroxaban treatment module captures the assessment, treatment and follow up of these patients – 100 to date. All primary care physician letters are generated within the system and sent electronically when possible . Conclusion: Implementation of the DVT electronic tool and record has standardised and recorded each part of the patient pathway facilitating audit, lean accountable practice and continuous improvement in workflow efficiency, quality and safety. The module also serves as a clinical database for benchmarking and research. Keywords: DVT, assessment, diagnosis, lean
What’s the added value? ‘In the nineteenth century health was transformed by clear clean water. In the twenty first century, health will be transformed by clean, clear knowledge. ‘
STP and rivaroxaban data Indication AgeBand Renalfunction Count Distal DVT - isolated calf <=50 Mild impairment 3 Distal DVT - isolated calf <=50 Normal 16 Distal DVT - isolated calf <=70 Mild impairment 6 Distal DVT - isolated calf <=70 Normal 9 Distal DVT - isolated calf <=70 Severe impairment 1 Distal DVT - isolated calf >70 Normal 2 Distal DVT - isolated calf >70 Severe impairment 2 Distal DVT in calf muscle <=50 Mild impairment 1 Distal DVT in calf muscle <=50 Normal 13 Distal DVT in calf muscle <=70 Mild impairment 4 Distal DVT in calf muscle <=70 Normal 11 Distal DVT in calf muscle <=70 Severe impairment 1 Distal DVT in calf muscle >70 Mild impairment 1 Distal DVT in calf muscle >70 Normal 3 Distal DVT in calf muscle >70 Severe impairment 5 DVT - PROVOKED <=50 Mild impairment 5 Outcome Treatment Count DVT - PROVOKED <=50 Normal 26 DVT - PROVOKED <=70 Mild impairment 8 Superficial Thrombophlebitis - 3 months anticoag LMWH (Dalteparin) 10 DVT - PROVOKED <=70 Normal 28 DVT - PROVOKED <=70 Severe impairment 1 Superficial Thrombophlebitis - 3 months anticoag LMWH + warfarin 20 DVT - PROVOKED >70 Mild impairment 9 DVT - PROVOKED >70 Normal 1 Superficial Thrombophlebitis - 3 months anticoag Rivaroxaban 30 DVT - PROVOKED >70 Severe impairment 7 DVT - UNPROVOKED <=50 Mild impairment 3 DVT - UNPROVOKED <=50 Normal 16 Superficial Thrombophlebitis - 6 wks anticoag LMWH (Dalteparin) 121 DVT - UNPROVOKED <=70 Mild impairment 9 DVT - UNPROVOKED <=70 Normal 25 Superficial Thrombophlebitis - 6 wks anticoag LMWH + warfarin 6 DVT - UNPROVOKED >70 Mild impairment 27 DVT - UNPROVOKED >70 Normal 13 Superficial Thrombophlebitis - 6 wks anticoag Rivaroxaban 51 DVT - UNPROVOKED >70 Severe impairment 16 Proximal DVT - cancer provoked <=50 Mild impairment 1 Superficial Thrombophlebitis requiring NSAIDs NSAIDs 48 Proximal DVT - reversible provoking factor <=50 Normal 7 Proximal DVT - reversible provoking factor <=70 Mild impairment 4 Proximal DVT - reversible provoking factor <=70 Normal 11 Proximal DVT - reversible provoking factor <=70 Severe impairment 1 Proximal DVT - reversible provoking factor >70 Mild impairment 5 Proximal DVT - reversible provoking factor >70 Normal 6 Proximal DVT - reversible provoking factor >70 Severe impairment 2 Proximal DVT - unprovoked <=50 Normal 3 Proximal DVT - unprovoked <=70 Mild impairment 2 Proximal DVT - unprovoked <=70 Normal 7 Proximal DVT - unprovoked <=70 Severe impairment 1 Proximal DVT - unprovoked >70 Mild impairment 9 Proximal DVT - unprovoked >70 Normal 1 Proximal DVT - unprovoked >70 Severe impairment 3 Superficial Thrombophlebitis <=50 Normal 1 Superficial Thrombophlebitis <=70 Mild impairment 1 Superficial Thrombophlebitis - 3 months anticoag <=50 Normal 9 Superficial Thrombophlebitis - 3 months anticoag <=70 Mild impairment 1 Superficial Thrombophlebitis - 3 months anticoag <=70 Normal 7 Superficial Thrombophlebitis - 3 months anticoag >70 Mild impairment 6 Superficial Thrombophlebitis - 3 months anticoag >70 Normal 5 Superficial Thrombophlebitis - 6 wks anticoag <=50 Mild impairment 1 Superficial Thrombophlebitis - 6 wks anticoag <=50 Normal 8 Superficial Thrombophlebitis - 6 wks anticoag <=70 Mild impairment 9 Superficial Thrombophlebitis - 6 wks anticoag <=70 Normal 13 Superficial Thrombophlebitis - 6 wks anticoag >70 Mild impairment 6 Superficial Thrombophlebitis - 6 wks anticoag >70 Normal 3 Superficial Thrombophlebitis - 6 wks anticoag >70 Severe impairment 2 Superficial Thrombophlebitis requiring NSAIDs <=50 Normal 1
Where next? • Follow up module • PE module • KPI, reports • Benchmarking • Trieennial audit Drive quality, value for money, equity of care
What is healthcare? A combination of: 1. Health services 2. Social care services 3. Wellbeing services 4. Housing 5. Education
Part of the digital revolution • IT ecosystems • Data usage • Data driving initiative • Clarity, bench marking, audit, referral,communication • Research • Enquiries • Integrated care delivery systems • High performance • Continuous improvement - data feedback, leadership
Are you going to join the revolution? • Integration, connectivity • IT ecosystems • SHIN-NY, Estonia digital health, e-patient power • Access across healthcare providers • Efficiency of administrative processes • Engagement of patient with their own record
New paradigms, new pyramids
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