Venous Thromboembolism (VTE) Risk Assessment Data Collection guidance

Changes since previous guidance

NHS England has reinstated the national collection of data regarding the completion of a VTE risk assessment for admission of adults to acute settings in England.

There are minimal changes from the previous version of this data collection.

As per the previous version, the data collection will still include admitted patients aged 16 and over. Mandatory data collection for VTE commenced in 2010. This guidance should be read in conjunction with the:

• NHS Standard Contract
• National Institute for Health and Care Excellence (NICE) thromboembolism guidance (NG89)

To support the collection of data, NHS England has clarified that risk assessment should be completed on admitted patients within 14 hours of admission. NICE guidelines state that where required, pharmacological thromboprophylaxis should be started within 14 hours of admission. Therefore, risk assessments should be completed prior to this, unless otherwise stated in the population-specific recommendations.  

Purpose of the data collection

The purpose of this data collection is to quantify the numbers and proportion of hospital admissions - aged 16 and over - who are being risk assessed for Venous Thromboembolism (VTE) within 14 hours of admission, to allow for the administering of appropriate prophylaxis based on national guidance from the National Institute for Health and Clinical Excellence (NICE).

The data collection is mandatory (DCB number: DAPB1593) and includes the requirement to report on admitted patients aged 16 and over.

Sampling methodologies and audit

This data collection is a census of patients. It is not appropriate to use sampling methodologies or audit to produce estimates. These are not included in the figures and are classed as a 'nil return'.

If you have not submitted a return before, contact [email protected] to begin the process.

This data collection asks for the following information:

1. Number of admitted patients (aged 16 and over at the time of admission) in the month who have been risk assessed for VTE within 14 hours of admission to hospital using the criteria in the NICE guidance.
2. Total number of admitted patients (aged 16 and over at the time of admission) in the month.

The percentage of admitted patients (aged 16 and over at the time of admission) in the month who have been risk assessed for VTE on admission is automatically calculated from items (1) and (2).

The mandatory data collection started in June 2010. It was paused during the pandemic and following a consultation process, has been reinstated and is ongoing until further notice.

Providers are required to collect data each month, but they only need to submit the return at the end of each quarter with each month covered separately.

Completion

The ‘VTE risk assessment – data collection’ must be completed and signed off by providers. A return is expected for each quarter covering each month of the quarter separately.

Submission dates

The collection will open on the first working day of the month following the end of the quarter data is being submitted for.

Submission deadline is the last working day of the same month.

Submissions after cut-off date

Submissions after the cut-off date can be made, but you will need to email our analytical services team at [email protected] before the data is submitted.

Registered data submitters of the data collection will receive monthly emails from Strategic Data Collection Service (SDCS) confirming when the reporting window is opening and closing.

Sign off policy

Data collection should be signed off at provider level by the chief operating officer/director or their directly delegated officer.

Revisions policy

Revisions before the cut-off date for submission of data are allowed and can be made as many times as necessary. The cut-off date is the last working day of the month.

Revisions after cut-off date

Revisions after the cut-off date must be submitted at one of the 2 scheduled revisions each year. These are opportunities for submitters to submit data for missed collections or submit revised data for collections previously submitted to. You will need to send a request before you make the revision to our analytical services team at [email protected], giving details of the changes.

Revision collection dates

The first scheduled revision collection for Q1 and Q2 will open on the 3rd Monday of December and close on the 4th Friday of December. The second scheduled revision collection for Q3 and Q4 will open on the 3rd Monday of June and close on the 4th Friday of June.

Scope of this data collection

Patients aged 16 and over admitted to acute hospital need to be risk assessed according to the criteria set out in the NICE guidance (NG89). Although NICE guidelines may differ for particular groups of patients (for example, medical versus surgical), all patients should be protected from illness or death from VTE.

The scope of this data collection therefore aligns with the current NICE guidance on VTE prevention and applies to both numerator and denominator.

The definition of inpatients applies to all patient classifications (1 to 5) set out in the NHS Data Model and Dictionary Service.

Patients who are not covered by NICE NG89 are out of scope of this data collection.

The data collection for this return is managed by NHS England via the Strategic Data Collection Service (SDCS). 

Table 1 below shows an example of the collection template. For each month in the quarter, providers must enter:

1. Number of admitted patients (aged 16 and over at the time of admission) in the month who have been risk assessed for VTE within 14 hours of admission to hospital using the criteria in the NICE guidance 
2. Total number of admitted patients (aged 16 and over at the time of admission) in the month (row ii)

The percentage of admitted patients (aged 16 and over at the time of admission) admitted in the month who have been risk assessed for VTE on admission is automatically calculated from items (1) and (2) (row iii). Quarterly totals, are automatically calculated. These figures cannot be overwritten. 

Guidance on the definitions that can be used to calculate row i and row ii is given in the Definitions section below.

In addition to the items collected above, providers can add supporting or explanatory comments in a box on the SDCS.

The form goes through validation checks after it is submitted. The upload will fail if:

• the number of patients admitted to the trust is 0
• the number of patients who have received a risk assessment is greater than the number of patients admitted

Providers need to fill in all 3 month columns. If you have data for only some of the months in the quarter, please add a comment to explain why this is.

Age on admission

The NHS Data Model and Dictionary defines the age on admission as ‘derived as the number of completed years between the PERSON BIRTH DATE of the PATIENT and the START DATE (HOSPITAL PROVIDER SPELL)’.

Admissions

For the purposes of the VTE risk assessment data collection the definition of an admission is subject to local arrangements for admission criteria.

By way of background, the NHS Data Model and Dictionary definition for hospital provider spell is intended to capture all patients who are admitted to hospital under local criteria irrespective of intended management.

The number of patients reported includes all admissions, irrespective of intended management, admission method or patient classification. These definitions can be found in the attributes section of the NHS Data Model and Dictionary.

Pre-admission assessments

Risk assessments undertaken pre-admission cannot be included in this data collection until the patient is admitted and the continued validity of the risk assessment at the point of admission is subsequently confirmed. At this point, the risk assessment does not need to be recorded twice in the data collection (that is, do not record one admission and two risk assessments).

Instead, for the purposes of this collection one patient is admitted and one patient has been risk assessed according to the NICE guidance, and this data is recorded for the month in which the admission occurs. The requirement is for the use of a tool published by a national UK body, professional network or peer-reviewed journal.

Transfers from another provider

The provider is responsible for ensuring that patients are risk assessed on admission using the criteria set out in the national VTE risk assessment tool, either by verifying the risk assessment undertaken by the transferring provider or by undertaking a new risk assessment.

Regular attenders

In the case of regular attenders over a period of time for the same clinical condition, they are required to be individually risk assessed on each admission. If a person is being admitted again for treatment, then it implies their condition may have changed.

Cohorts of patients

A ‘cohort approach’ to risk assessment using a national VTE risk assessment tool may be considered locally for certain cohorts of patients undergoing certain procedures where the cohort of patients share similar characteristics and are not at risk of VTE according to the NICE guidance. A cohort approach to risk assessment can only be used when the trust’s medical director is satisfied that, when reading the NICE guidance, it would always result in the determination that the patient is not at risk of VTE, or that under the NICE guidance no pharmacological or mechanical prophylaxis would be appropriate regardless of the risk factors.

Any such local protocols must be agreed with the trust or hospital medical director and included in local VTE governance policy and audits. The trust/hospital medical directors will be responsible for signing off that the VTE risk assessment being used at a local level is fully compliant with the criteria set out in the NICE guidance and that all risk factors have been taken into account.

For the purpose of patients in scope for this data collection, they should be counted individually in the numerator and denominator regardless of whether they have been risk assessed individually or as part of a cohort.

Local risk assessment tools and procedures

We realise that some providers already have risk assessment procedures in place, but confidence in the mandatory data collection requires that any audit can clearly demonstrate that the clinical risk assessment criteria described in the national VTE risk assessment tool (as published) are being employed in full. We expect trust/hospital medical directors to sign off that the VTE risk assessment being used at a local level fully complies with a national tool.

OPCS codes

NHS England has no plans to issue OPCS codes that would allow providers to determine whether a VTE risk assessment has been carried out at the point when a patient is discharged.

For general VTE data collection and data queries, please email [email protected]. 

For questions related to VTE prevention or safety improvement, please email [email protected].