NICE consults on new draft quality standard for management of VTE diseases

NICE has today (3 October) opened a consultation on a new draft quality standard for the management of venous thromboembolic (VTE) diseases. The draft quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with venous thromboembolic diseases.

VTE diseases cover a spectrum ranging from asymptomatic deep vein thrombosis (DVT) to fatal pulmonary embolism (PE). They are the result of a blood clot (a thrombus) forming in a vein and then dislodging to travel in the blood (an embolus). If the blood clot dislodges and travels to the lungs, this can lead to a potentially fatal PE. Even if blood clots are non fatal, they can still result in long-term illness, including venous ulceration and development of a post-thrombotic limb (chronic pain, swelling and skin changes in the affected limb) and have a significant impact on quality of life.

Risk factors for VTE include a history of DVT, age over 60 years, recent surgery/serious injury, obesity, prolonged travel, acute medical illness, immobility and pregnancy. Cancer is also a significant risk factor for blood clots and people with cancer have an estimated fourfold increased rate of blood clots compared with people who do not have cancer. Latest figures (from 2010/11i) show that over 56,000 people - around 1000 per week - were diagnosed with blood clots in their legs or lungs. Evidence suggests that as many as 50% of people in whom a blood clot in the leg is left untreated will go on to develop a blood clot in their lung.

The draft quality standard contains six statements for the care of people with a suspected or confirmed VTE. The statements include ensuring people with suspected VTE diseases have diagnostic investigations completed within 24 hours of first clinical suspicion. It also states that people with suspected deep vein thrombosis, where diagnostic investigations take longer than 4 hours from the time of first clinical suspicion, are offered interim therapeutic dose anticoagulation therapy. In the case of people with suspected PE, the draft quality standard states that they should be offered interim therapeutic dose anticoagulation therapy where diagnostic investigations take longer than 1 hour. In addition it states that people with unprovoked venous thromboembolic diseases are offered investigations for cancer.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: "Despite the fact that VTE is recognised as an important cause of death or morbidity, and its prevention and management have become priorities for the NHS, every year thousands of people die in the UK of as the result of a blood clot, many of them unnecessarily. We are, therefore, very pleased to be publishing this draft quality standard for VTE diseases, which will contribute to improving the diagnosis and treatment of people with a DVT or PE by providing a focus on key elements of quality improvement. Registered stakeholders now have the opportunity to submit their comments on the draft quality standard via the NICE website."

This document is not NICE's final quality standard on the management of VTE diseases. The statements and measures presented are provisional and may change after consultation with stakeholders.

All eligible comments will be reviewed by the independent Topic Expert Group and the standard may be refined in light of this information. The final quality standard for VTE diseases is expected to be published in April 2013.


Notes to Editors

References and explanation of terms

i. Hospital Episodes Statistics for 2010/11

About the quality standard

1. The draft quality standard is available on the NICE website from Wednesday 3 October at:

The deadline for stakeholder comments is Wednesday 31 October.

Embargoed copies are available on request; please contact the press office.

2. NICEquality standards (QS) are a set of specific, concise statements and measures that act as markers of high-quality, clinical and cost-effective patient care. They apply nationally in health and social care, and are developed from the very best available evidence, such as NICE guidance or other NHS Evidence-accredited sources. Quality standards are produced with the NHS and social care, along with their partners, service users and carers. They are a pivotal part of the new NHS Outcomes Framework, an overview of aims and objectives in improving patient outcomes in the NHS.

3. Quality standard topics are referred to NICE by ministers on the advice of the National Quality Board, a group of representatives from health and social care, committed to improving quality in the NHS and overseeing the reforms aimed at improving care. Further information on the National Quality Board.

4. More information on NICE quality standards.

Related guidelines and quality standards

1. Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. NICE clinical guideline 144 (2012).

2. Venous thromboembolism prevention quality standard. NICE quality standard 3. (2010).

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

  • public health- guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies- guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice- guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • Quality standards- these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.

4. NICEprovides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 04 October 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.