Redesigning a DVT pathway. Improving care, saving (a lot of) money

another story that I’ve been meaning to tell

Another story that may never see the light of day in a scientific journal.

another unpublished manuscript. Use your judgement in interpreting. Two of the authors (GF / MRF) have well documented DOI.

Feel free to use and steal in any way you want. there’s a hell of a back story to this one. email either of us.

this one is the brainchild of Matt Fay – @fatherofhan

with the sweat and toil of many others. Most notably Clare Smart @smartotley


abstract here:

Redesign and implementation of a deep-vein thrombosis pathway reduces healthcare utilisation costs and improves patient care

Authors: Matt Fay, Sam Ackroyd, Carol Aitken, Mark Kon, Robert Halstead, Clare Smart, Greg Fell



The current patient care pathway for acute deep-vein thrombosis (DVT) requires clinicians in primary care to refer patients with suspected DVT to hospital for diagnosis, who then often experience significant delays in receiving treatment in busy accident and emergency (A&E) departments and medical assessment units (MAUs), with associated cost implications. If confirmed, patients are discharged on low-molecular-weight heparin and warfarin, with community monitoring until stable. Overall, the pathway is poorly understood and there is poor compliance from both patients and clinicians. To address this, the DVT pathway in Bradford was redesigned so that all patients are assessed in primary care, and those with suspected DVT are initially treated with rivaroxaban. Patients with confirmed DVT continue to be managed as an outpatient, thereby reducing hospital admissions.

This paper reports the economic impact of the redesigned pathway in a population of 440,000 patients in Bradford, UK. After considering the cost of additional diagnostic testing in general practice and supply of rivaroxaban to all patients with suspected DVT, a significantly reduced number of MAU and A&E admissions resulted in a net saving of £230,453.

For those patients with confirmed DVT who continue to receive rivaroxaban, reduced spending on international normalised ratio clinics contributes to a further saving of £28,280.

Taken together, the redesigned DVT pathway provides a significant cost saving of approximately £260,000 compared with the previous hospital-based model. The pathway is also expected to increase patient compliance with disease management and therefore improve overall health outcomes.

full story here:



back story and slides available by email




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