Can advanced clinical practitioners autonomously manage lower limb deep vein thrombosis? A clinical audit

Background: This audit evaluates the compliance of advanced clinical practitioners (ACPs) in managing lower-limb deep vein thrombosis (DVT) in an ambulatory emergency care (AEC) clinic of an NHS trust. Compliance was measured against national standards set by NICE. Aim: To review whether ACPs can independently manage patients without the need for a second review by a consultant. Methods: Data for 12 months (from 2021–2022) were reviewed for patients with DVT to assess the timing of ACP clerking and consultant review. Audit standards were established, focussing on the following criteria: Wells score documentation, D-dimer results, anticoagulation prescribing, and ultrasound and blood test requests. Findings: A total of 48 patients waited an average of 2 hours and 37 minutes between ACP and consultant review. Wells scores were documented in 56% of cases and 97% of the patients who needed a D-dimer test had one available. ACPs prescribed appropriate anticoagulation in 100% of cases and ultrasound imaging was requested in all cases. Baseline blood tests were requested in 98% of cases. Conclusions: ACPs were compliant in 4/5 standards at >95%. This audit identified significant time savings and patient and clinician satisfaction was achieved through autonomous ACP practice. Implications for practice: There is scope for improved autonomy of ACPs and the potential for improved patient flow, reduced workload for consultant physicians and enhanced patient experience as a result.