Title : Compliance with venous thromboembolism risk assessment in trauma and orthopaedic inpatients: A clinical audit
Abstract:
Background and Aim: Hospital-acquired Venous ThromboEmbolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common and potentially preventable complication of hospital admission. Trauma and orthopaedic patients are particularly vulnerable because of factors including injury, surgery and reduced mobility. NICE guideline NG89 recommends that all surgical and trauma patients undergo assessment of both VTE and bleeding risk as soon as possible following admission or by the time of first consultant review. This audit aimed to assess compliance with VTE risk-assessment requirements among Trauma and Orthopaedic inpatients on Hurley Ward and identify opportunities to improve adherence to national and local standards. The audit standard was 100% of eligible patients having a documented VTE risk assessment.
Methods: A retrospective clinical audit was conducted at three time points between 7 July and 5 August 2026. Adult Trauma and Orthopaedic inpatients on Hurley Ward were identified using ward admission lists and the Electronic Patient Record (EPR). Day-case patients, patients aged under 18 years and those with insufficient documentation were excluded. Electronic patient records were reviewed using a standardised data collection tool to determine whether a VTE risk assessment had been completed and documented. Twenty-eight patients were reviewed on 7 July, 30 on 18 July and 27 on 5 August, giving 85 patient assessments across the three audit dates. Compliance was compared with the target standard of 100%.
Results: On 7 July, 12/28 patients (42.9%) had a documented VTE risk assessment. Compliance increased to 19/30 (63.3%) on 18 July before decreasing to 14/27 (51.9%) on 5 August. Across all three audit dates, 45/85 patient assessments (52.9%) had a documented VTE risk assessment, while 40/85 (47.1%) did not. Compliance on the final audit date was 9.0 percentage points higher than at baseline, although it remained substantially below the target standard of 100%.
Conclusion: This audit identified suboptimal compliance with VTE risk-assessment documentation among Trauma and Orthopaedic inpatients, with only 52.9% overall compliance. Although there was some improvement from the first to final audit date, the target standard was not achieved. The findings highlight the need for targeted measures to improve VTE risk assessment and documentation, including staff education, incorporation of VTE assessment into routine admission processes and regular monitoring. A further audit following implementation of these measures would help determine whether improvements can be sustained.
