As part of Thrombosis UK's commitment in raising Awareness, Research and Care of Thrombosis. Our own Annya Stephens-Boal was part of the the research committee for the following new study.

Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis

The study found that the use of novel oral anticoagulants has advantages over warfarin in patients with atrial fibrillation, but there was no strong evidence that they should replace warfarin or low-molecular-weight heparin in the primary prevention, treatment or secondary prevention of venous thromboembolic disease.

Read the full report

or visit: https://www.journalslibrary.nihr.ac.uk/hta/hta21090/#/abstract

Quality Watch: Emergency readmissions to hospital for potentially preventable conditions on the rise, new research shows

The number of patients being readmitted to hospital in an emergency with potentially preventable conditions such as pneumonia and pressure sores has grown significantly in the last seven years, analysis from The Nuffield Trust think tank shows today.

The new findings from QualityWatch, a major research programme from the Nuffield Trust and the Health Foundation, looked at hospital data detailing patient diagnoses and the reasons behind emergency hospital readmissions between 2010/11 and 2016/17. The analysis aims to highlight where improved quality of care in hospital or the community might have prevented readmission.

The analysis tracks a 19% rise in patients being readmitted to hospital in an emergency within 30 days of discharge between 2010/11 and 2016/17. Within this, the author identifies a 41.3% rise in emergency readmissions for conditions they classify as “potentially preventable”. These “potentially preventable” readmissions include patients with pneumonia, pressure sores and venous thromboembolism (VTE) and were conditions that patients were not diagnosed with when they were first admitted to hospital.

According to the author, these findings should raise questions about the quality of care that our elderly population are receiving during their hospital stay, how they are discharged from hospital and the quality of community and social care services.

Key findings:

  • Between 2010/11 and 2016/17, the number of emergency readmissions within 30 days increased from 1,157,570 to 1,379,790, a rise of 19.2%. The proportion of patient hospital stays that were followed by a readmission grew from 7.5% to 8%.
  • Potentially preventable emergency readmissions to hospital grew from 130,760 to 184,763 - an increase of 41.3%. This means that the proportion of patient hospital stays that were followed by these types of readmission grew from 0.8% in 2010/11 to 1.1% in 2016/17.
  • Patients readmitted to hospital in an emergency with pneumonia increased from 41,003 in 2010/11 to 70,731 in 2016/17, an increase of 72.5%. The increase in pneumonia readmissions was greater than the overall increase in pneumonia cases.
  • Emergency readmissions for pressure sores almost trebled from 7,787 in 2010/11 to 22,448 in 2016/17. The increase in the number of patients being readmitted with a pressure sore superseded the overall increase in the number of pressure sore diagnoses in hospital.
  • The number of patients readmitted with venous thromboembolism grew by a third, from 16,890 in 2010/11 to 23,006 in 2016/17.

While the findings may point towards changes in coding practices of conditions in hospital, as well as a rapidly growing frailer and older population, the findings show there is a good opportunity for local health providers and policy makers to target their quality improvement efforts.

Director of Research at the Nuffield Trust, Professor John Appleby said:
“Unnecessary trips and overnight stays in hospital put a strain on elderly patients and their families. That is why it’s concerning that our research shows the number of people being readmitted to hospital within 30 days with potentially preventable conditions is greater than it was seven years ago.”

Briefing author Jessica Morris, Research Analyst at the Nuffield Trust said:
“Emergency readmissions to hospital, for conditions that were not diagnosed during their first visit, are potentially a warning sign that a patient’s quality of care may have been compromised.
“The findings provide local health providers with a good opportunity to sit up and focus their attention and quality improvement initiatives on the three conditions where we’ve seen the most significant rise in readmissions.”

  1. Publicly available data on emergency readmissions has not been available since December 2013, as NHS Digital have delayed indicator updates pending a methodology review.
  2. Emergency readmissions: Trends in emergency readmissions to hospital in England examines trends in emergency readmissions for all acute hospital trusts in England using Hospital Episode Statistics (HES) data. Written by Nuffield Trust research analyst Jessica Morris, the analysis will be published on the QualityWatch website at 0001 Friday 1st June.
  3. QualityWatch is a joint programme by the Nuffield Trust and Health Foundation providing independent scrutiny of health and social care quality data. The programme monitors over 300 care quality indicators, which are published on the QualityWatch website. It also publishes research reports, news and blogs about care quality and data. www.qualitywatch.org.uk
  4. The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
  5. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Our aim is a healthier population, supported by high quality health care.

For more information please contact:
Kirsty Ridyard on 0207 462 0552 / Kirsty.ridyard@nuffieldtrust.org.uk
Leonora Merry on 0207 462 0555 / Leonora.merry@nuffieldtrust.org.uk

The Nuffield Trust has an in house ISDN line for radio interviews.

Thrombosis UK offer up Travel Fellowship grants to a maximum value of £1,000.

Read more about the work undertaken as a result of Thrombosis UK Travel Fellowship grant support:

Dr Colin Evans

Dr Colin Evans is a Postdoctoral Research Associate in the laboratory of Professor Randall Johnson at the Department of Physiology, Development and Neuroscience, University of Cambridge.

His current research investigates mechanisms that regulate the strong positive association between cancer and venous thrombosis - Read More

Dr Sian Sweetland

I am a Statistical Epidemiologist in the Cancer Epidemiology Unit, University of Oxford.

My current research investigates the relationship between cancer and venous thromboembolism using questionnaire data from a large UK cohort, the Million Women Study, linked to NHS hospital admissions records, cancer registrations and deaths - Read More

Gael Morrow

I am a 3rd Year PhD Student at the University of Aberdeen in Dr Nicola Mutch’s Lab.

My PhD project has focused on determining the role of platelets in fibrinolysis (the process of breaking down a blood clot). Our laboratory has found that proteins important in fibrinolysis and coagulation are retained on the surface of activated platelets in a protruding "cap" - Read More