The Technology

T l is an exp ert clinical decision support system (CDSS) th a t was used to assess th e risk of

patients developing VTE in acute hospital settings. It was designed to assist clinicians to

system atically assess VTE risk a t th e point of care fo r hospitalised patients. T l was based

on NICE guidelines fo r th e prevention and tre a tm e n t o f VTE. It was developed by an in-

house m ulti-disciplinary te a m o f clinicians, nurses, ICT project managers and technicians

and senior Trust executives. T l replaced th e paper-based VTE risk assessment tool which

had been in use fo r several years in th e study Trust. H ow ever, th e paper-based tool was

not w id ely used and thus did not provide th e study Trust w ith ad eq u ate au d it data to m e e t

th e expected requirem ents. T l was expected to im prove clinical decision m aking and

p a tie n t outcom es as w ell as collection and presentation o f data in a fo rm a t th a t w ould

satisfy th e requirem ents o f regulatory authorities and ensure th a t th e study Trust secured

funding fo r m eeting VTE CQUIN targets as set by th e commissioners.

How T l works

T l autom atically populated th e patient's dem ographic data fro m th e study Trust's existing

clinical results reporting system using a p atien t specific NHS n u m b er or locally allocated

hospital num ber. To initiate th e VTE risk assessment, users w e re required to input th e

p atien t's clinical data by ticking relevant boxes as applicable. T l th en processed th e

p atien t's data and recom m ended appropriate actions depending on th e level o f risk

presented. These actions included prescription o f ap p ro p riate throm boprophylaxis on th e

p aper drug charts based on th e patient's w eight, pre-existing risk factors and blood

results. Additionally, T l also calculated th e ap p ro p riate dose o f throm boprophylaxis

based on th e clinical inform ation provided. The user was th en p rom pted to confirm th a t

th e y had prescribed th e throm boprophylaxis dose as recom m ended. In cases w h e re it was

explanation using a free te x t box provided, noting th e reasons fo r deviation. A t this point,

th e to p part o f th e patient's electronic profile changed to a m b e r colour to indicate th a t

VTE risk assessment has been initiated. W ith in 24 hours o f admission, users w e re required

to reassess th e patient's risk, particularly bleeding risk or any change in th e patient's

condition. W h e re th e risk was deem ed m inim al, th e risk assessment was com pleted and

th e to p p art o f th e patient's profile changed colour to green. W h e re th e risk o f bleeding

or o th e r adverse event becam e im m inent, th en a fu rth e r risk assessment was required

before com pletion and th e profile colour code rem ained am b er. In instances w h e re VTE

risk assessment had not been initiated w ith in 24 hours, th e colour code au to m atically

changed to red, indicating th a t VTE risk assessment was overdue. The "traffic light system"

(G reen, A m ber, and Red) was incorporated into T1 because it was being used on th e

existing risk assessments w ithin th e study Trust and clinical staff w e re already fam iliar

w ith th e sequence o f th e colour codes. The study Trust's In fo rm atio n D e p a rtm e n t

electronically collected and subm itted to th e national database th e to ta l n u m b e r of

m onthly admissions and valid VTE risk assessments th a t had been carried out, i.e., those

initiated and com pleted w ith in 24 hours o f admission.

Expected benefits of T1

T1 was customised to suit existing w o rk stream s in th e study Trust and to ensure

com patibility w ith existing legacy systems. The custom isation was prim arily done to

enable th e collection and reporting of audit data as required by th e com m issioners and

regulatory authorities. The project team expected T1 to be safe to use and also th a t it

w ould im prove w o rk processes and th e overall VTE m an ag em en t system. It was th e first

such system to be developed in th e UK and w e n t on to w in regional and national aw ards

fo r innovation.