Date of prep: December 2020
Prescribing information and
adverse events reporting
For healthcare professionals only
A new report has highlighted concerns over delays in treatment and a lack of follow-up care for potentially fatal lung blood clots.
The study, carried out by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), examined the care of patients with a new diagnosis of pulmonary embolism in hospitals across the UK.
A pulmonary embolism (PE) is a blocked blood vessel in the lungs, which most commonly occurs due to blood clots travelling from the legs, known as a deep vein thrombosis.
It can affect all age groups and is associated with air travel, hospitalisation, active cancer, pregnancy and some chronic conditions.
In nearly four out of ten cases – 38% – one or more delays in care were identified including in recognition of the condition, investigations and treatment.
One fatal case involved a middle-aged patient with respiratory disease, who went to hospital with symptoms after a four-hour flight, but admission to critical care was delayed due to a lack of beds.
The researchers warned treatment should be given at the earliest opportunity and not delayed by bed availability.
An avoidable delay in starting anticoagulation medication to prevent blood clots was found in nearly a fifth – 18% – of patients.
The study also concluded follow-up care was inadequate for 16% of patients following a diagnosis of pulmonary embolism.
In one example, one young patient who developed the condition following a road accident was sent home from hospital with a plan for surgical follow-up but none for pulmonary embolism. The discharge letter also did not provide any advice to the patient’s GP.
Despite advances in the prevention, diagnosis and treatment of PE, the report notes pulmonary embolism remains an “important cause of morbidity and mortality.”
It is linked to an estimated 25,000 hospital deaths in the UK each year and studies have shown for every case of a non-fatal pulmonary embolism which is diagnosed, there are 2.5 fatal cases which had not been detected.
Ian Martin, chair of NCEPOD, said pulmonary embolism (PE) can be “catastrophic” and affect young and otherwise healthy patients.
He said: “The report stresses the importance of undertaking and documenting a PE probability score for all patients with a suspected PE, and ensuring that a standardised protocol is followed, to ensure the consistent delivery of an appropriate package of care in an appropriate setting.
“The report identifies that avoidable delays are occurring in relation to access to investigations and senior clinical review.
“Given the high mortality risk it is imperative that delays are kept to a minimum, and therapy is initiated as soon as possible.”
Pharmacy in Practice is a UK pharmacy publication with its roots in Scotland.