HNY Policy and Pathway Repository - Humber

The nurse-led community DVT service will provide high-quality, standardised and clinically effective holistic assessments, diagnostic testing, management and treatment to patients who have a suspected DVT. The service will provide optimum care to patients, reducing the risk of extension of existing event and further thromboembolic events whilst providing expertise in the management of DVT.

A DVT screening service is available for pregnant patients in addition to a referral pathway for those patients who are under the care of a HMP setting, and a rescan and review pathway for those patients with suspected DVT presenting to the acute trust who require a rescan following hospital discharge.   

Operational hours are Monday to Saturday between the hours of 09:30 and 18:00 -including bank holidays (excluding Christmas day).  Outside of these hours, there is a dedicated DVT pathway delivered by the Urgent Care service.

Referrals are accepted from Hull and East Riding General Practitioners (GP) or other health care professionals via telephone 01482 247111*.   Inclusion and exclusion criteria for referral is detailed below. Referring clinicians will be asked service specific standardised questions at the time of referral to ensure the patient meets the service inclusion criteria, if the patient is deemed complex or unsuitable a DVT clinician will contact the referrer within 30 minutes to discuss the appropriate care pathway. Once the referral is accepted the referring clinician will be requested to complete an electronic referral form and send to CHCP.dvtservice@nhs.net.

The service will not accept any clinical responsibility for patients referred to the service by email with no prior telephone call or discussion with a member of the DVT team

• Chest pain or new onset shortness of breath (SOB)
• Severe hepatic impairment, patients who are jaundiced, or under specialist treatment for liver disease
• Severe renal impairment Glomerular Filtration Rate (GFR) <30 ml/min/1.73 m2.
• Confirmed bleeding disorder
• Heparin Induced osteoporosis/thrombocytopenia
• Uncontrolled hypertension > 180/100 (>80 years 200/120)
• Active bleeding e.g., intra-cerebral bleed within the last 6/12 – due to higher risk of haemorrhage
• Endocarditic/ Septic Endocarditic – due to higher risk of haemorrhage
• High bleeding risk i.e., recent peptic ulcer disease/oesophageal varices
• Any brain or spinal surgery within 6 months
• Suspected pulmonary embolism
• Patients unwilling or likely to be unable to co-operate with the service
• Suspected spontaneous bilateral DVT

Patients presenting with the above will need to be referred to the acute trust – same day medical assessment unit (SDEC)

Exclude Red Flag Symptoms

As below – referrals will not be excepted for patients that fall within the exclusion criteria

DO NOT REFER

• Patients under 18 years of age
• Patients not registered with a Hull or East Riding GP
• Suspected thrombosis of the upper limbs
• Patients that are non-ambulatory requiring moving and handling equipment 
• Patients with complex multiple medical conditions that the nurse led team will be unable to manage in terms of assessment and or anticoagulation

Patients with:

• Severe hepatic impairment, patients who are jaundiced, or under specialist treatment for liver disease
• Severe renal impairment Glomerular Filtration Rate (GFR) <30 ml/min/1.73 m2.
• Confirmed bleeding disorder
• Heparin Induced osteoporosis/thrombocytopenia
• Uncontrolled hypertension > 180/100 (>80 years 200/120)
• Active bleeding e.g., intra-cerebral bleed within the last 6/12 – due to higher risk of haemorrhage
• Endocarditic/ Septic Endocarditic – due to higher risk of haemorrhage
• High bleeding risk i.e., recent peptic ulcer disease/oesophageal varices
• Any brain or spinal surgery within 6 months
• Suspected pulmonary embolism
• Patients unwilling or likely to be unable to co-operate with the service
• Suspected spontaneous bilateral DVT

Please review the inclusion criteria prior to referral. In the event the patient does NOT meet the service specific referral criteria please refer to the acute trust for assessment and management.

Overview | Venous thromboembolic diseases: diagnosis, management and thrombophilia testing | Guidance | NICE

Inclusion criteria:

• Patients aged 18 years of age and over
• Suitable for ambulatory care
• Stable medical condition
• Alcohol or substance misuse under stable clinical care with another primary health care professional/ service
• Patient concordance with treatment

Referrals are accepted from Hull and East Riding General Practitioners (GP) or other health care professionals via telephone 01482 247111*.   Inclusion and exclusion criteria for referral is detailed within this document.

Referring clinicians will be asked service specific standardised questions at the time of referral to ensure the patient meets the service inclusion criteria, if the patient is deemed complex or unsuitable a DVT clinician will contact the referrer within 30 minutes to discuss the appropriate care pathway. Once the referral is accepted the referring clinician will be requested to complete an electronic referral form and send to CHCP.dvtservice@nhs.net.  

The service will not accept any clinical responsibility for patients referred to the service by email with no prior telephone call or discussion with a member of the DVT team

Referrals

As above.

A date and time of appointment with the DVT service will be given to the referring clinician at the time of referral. It’s the referring clinician’s responsibility to inform the patient of appointment details.

Information to include

• Electronic referrals emailed to CHCP.dvtservice@nhs.net.
• Please ensure that patients Electronic Care Record (ECR) is shared prior to referral.