Venous Thromboembolism (VTE) Risk Assessment Data Collection guidance

This guidance supports providers in completing the mandatory VTE Risk Assessment Data Collection. It should be read in conjunction with the National Institute for Health and Care Excellence (NICE) venous thromboembolism guideline NG89.

The legal basis to collect the data is the migration and continued operation of the Unify2 collections through Strategic Data Collections Service Direction alongside the Venous Thromboembolism (VTE) Risk Assessment Data Provision Notice

NICE guideline NG89 has also been updated to require risk assessment of patients who have been in accident & emergency (A&E) for 12 hours or more.  It is recognised that this updated guidance will require providers to make the appropriate changes to their processes, both clinically and in relation to data recording. In recognition of this transition, this VTE Risk Assessment Data Collection will not yet require data on patients who have been in accident & emergency (A&E) for 12 hours or more (or  same day emergency care (SDEC)). However, once sufficient progress has been made in changing processes to reflect this requirement for risk assessing patients who have been in A&E for 12 hours or more, the collection is likely to be updated.

The purpose of this data collection is to quantify the numbers and proportion of acute hospital patient admissions aged 16 and over who are being risk assessed for Venous Thromboembolism (VTE) within 14 hours of decision to admit¹, to allow for the administering of appropriate prophylaxis based on NICE guideline NG89.

NICE guideline NG89 states that where required, pharmacological thromboprophylaxis should be started within 14 hours of decision to admit. Therefore, risk assessments should be completed prior to this, unless otherwise stated in the population specific recommendations.  

The data collection commenced in June 2010 and is mandatory DAPB1593 Amd74/2023. 

Who must complete the data collection

All providers of NHS-funded acute hospital care (including foundation trusts and independent sector providers of acute NHS services) must complete this data collection. Providers of non-acute health services are not asked to complete this data collection, although they should be aware that all patients should be protected from unnecessary risk of VTE. Email [email protected] for any queries.

Which patients are in and out of scope

Patients aged 16 and over admitted to an acute hospital need to be risk assessed according to the criteria set out in the NICE guideline NG89. Although NICE guideline NG89 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 applies to both numerator and denominator.

Patients in scope

All patients aged 16 and over at the time of admission including: 

• surgical inpatients
• pregnant women and women who gave birth or had a miscarriage or termination of pregnancy in the past 6 weeks
• inpatients with acute medical illness (for example, myocardial infarction, stroke, spinal cord injury, severe infection or exacerbation of chronic obstructive pulmonary disease)
• trauma inpatients and trauma patients being immobilised with a cast or brace, including those treated as outpatients and discharged straight after
• patients admitted to intensive care units
• cancer inpatients
• people undergoing long-term rehabilitation in hospital
• patients admitted to a hospital bed for day-case medical or surgical procedures
• private patients attending an NHS hospital

See considerations for VTE risk assessments below for more detail on handling data collection for:

• the repeated risk assessment of regular day-case attendees
• permitted approaches to risk assessment for particular cohorts of patients

Patients out of scope

• people under the age of 16 at admission
• people attending hospital as outpatients (other than patients admitted to a hospital bed for day-case medical or surgical procedures, as listed above)
• people attending hospital A&E departments and same day emergency care (SDEC) who are not admitted as inpatients (other than patients being immobilised with a cast or brace). This position will be kept under review as providers embed processes to risk assess patients who have been in accident & emergency (A&E) for 12 hours or more and is likely to be updated in future collections once sufficient progress has been made.
• people who are admitted to hospital because they have a diagnosis of deep vein thrombosis (DVT) or pulmonary embolism
• patients who are not covered by NICE guidelines NG89 are out of scope of this data collection 

Data items

This data collection asks for the following information:

1. Number of acute hospital patient admissions (aged 16 and over at the time of admission) in the month who have been risk assessed for VTE within 14 hours of decision to admit¹ using the criteria in the NICE guideline NG89. 
2. Total number of acute hospital patient admissions (aged 16 and over at the time of admission) in the month.

The percentage of acute hospital patient admissions (aged 16 and over at the time of admission) in the month who have been risk assessed for VTE within 14 hours of decision to admit¹ is automatically calculated from items (1) and (2).

This data collection is a census of patients in scope. This means that it is not appropriate to use sampling or audits to produce estimates. Submissions calculated via these means will be excluded from the national figures.

Data collection

This data collection  is managed by NHS England via the Strategic Data Collection Service (SDCS). 

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

How to submit

Submit data through the Strategic Data Collection Service (SDCS).

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

Submission frequency

Providers are required to collect data each month, but they only need to submit the monthly returns at the end of each quarter.

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.

Late submissions

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.

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 purpose of the VTE Risk Assessment Data Collection the definition of an admission is as per NICE guideline NG89: An inpatient, where a bed is provided for 1 or more nights, or admission as a day patient, where a bed is provided for a procedure including surgery or chemotherapy but not for an overnight stay.  

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 guideline NG89, and this data is recorded for the month in which the admission occurs.

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 guideline NG89. A cohort approach to risk assessment can only be used when the trust’s medical director is satisfied that, when reading the NICE guideline NG89, it would always result in the determination that the patient is not at risk of VTE, or that under the NICE guideline NG89 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 guideline NG89 and that all risk factors have been taken into account.

For 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. For example, a cohort of 10 patients would be included as 10 in the numerator and 10 in the denominator. 

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.

Risk assessment tool

The requirement is for the use of a tool published by a national UK body, professional network or peer- reviewed journal.  

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.

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 third Monday of December and close on the 31 December. The second scheduled revision collection for Q3 and Q4 will open on the third Monday of June and close on the fourth Friday of June.

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

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