L. Almasri1, L. C. Barwell1, H. B. Ahmed1, R. Sabaratnam2, K. E. Nicholson2

1King's College London, UK

2Evelina London Children's Hospital, London, UK


Venous Thromboembolism (VTE) is an uncommon perioperative risk in children, occurring in 0.04-8.9% of surgical cases (Mets et al., 2020), that causes significant morbidity. Royal College of Anaesthetists (RCoA) Guidelines for the Provision of Anaesthetic Services (GPAS) have mandated that paediatric anaesthesia services have a VTE guideline (GPAS, 2024). National Institute for Health and Care Excellence (NICE) state that patients older than or equal to 16 years old require VTE assessment within 24 hours (NICE, 2023). Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) published paediatric VTE guidelines in 2017 (APAGBI, 2017). Staff involved in the perioperative care of children require appropriate knowledge and skills to minimise their risk of VTE.


An initial survey at Evelina London Children’s Hospital (ELCH) - a tertiary NHS hospital – demonstrated that:

  • 72% of anaesthetists rated their knowledge of paediatric VTE prophylaxis ‘average’ or ‘poor’.
  • 53% felt ‘neutral’ or ‘not confident’ correctly prescribing VTE prophylaxis.
  • 76% knew patients >13 years old should be assessed for VTE prophylaxis.

Strategy for Change

To provide knowledge-based education to the clinical team alongside launch of 2023 approved prophylaxis guideline and ensure accessibility to appropriate protocols:

1)         Educational email to relevant clinical staff with results from initial survey and information regarding guidelines.

2)         Display of paediatric VTE guidelines to trust VTE guidelines app (GSTT Thrombosis App) in collaboration with app committee for smartphone-friendly access.

3)         Reminder posters in all operating theatres to prompt assessment and documentation of eligibility and decision making, with QR codes linking Thrombosis App.

4)         Presentation at trust paediatric anaesthetics clinical governance meeting.

Improvement Measures

A second survey was circulated following our initial educational intervention to assess change in clinical knowledge and confidence.

The results showed:

  • 77% of anaesthetists rated their knowledge ‘average’ or ‘poor’.
  • 62% felt confident prescribing VTE prophylaxis to the correct population.
  • 82% were not aware of or used the Thrombosis app.

Lessons Learnt

  • Follow-up survey after educational interventions demonstrated slightly improved confidence in identifying and prescribing VTE prophylaxis, but the educational interventions did not result in improvement of reported knowledge levels amongst respondents.
  • Smartphone-friendly means of access (Thrombosis app) was not utilised by clinicians as predicted, despite efforts to guide towards app through poster and presentation interventions.

Message for Others

Our results show that emails alone are insufficient in achieving successful education. Information should be widely communicated and regularly shared. Data gathering and continuous feedback cycling should be used as a way of frequently assessing intervention impact and progress towards aims. The responding group of clinicians also displayed a low uptake of this app – this should also be borne in mind when deciding to invest in a supportive app for clinicians, but further demonstrates need for a multi-dimensional educational approach.


  1. Mets EJ, McLynn RP, Grauer JN. Venous thromboembolism in children undergoing surgery: Incidence, risk factors and related adverse events. World Journal of Pediatric Surgery. 2020 Apr 14;3(1). doi:10.1136/wjps-2019-000084
  2. National Institute for Health and Care Excellence (NICE). Overview: Venous thromboembolism in over 16s: Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism: Guidance [Internet]. 2018 [cited 2024 Feb 8]. Available from: https://www.nice.org.uk/guidance/NG89
  3. Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI). Prevention of peri operative venous - APAGBI [Internet]. 2017 [cited 2024 Feb 8]. Available from: https://www.apagbi.org.uk/sites/default/files/inline-files/APA%20Thromboprophylaxis%20guidelines%20final.pdf
  4. The Royal College of Anaesthetists. Chapter 10: Guidelines for the provision of paediatric anaesthesia services 2024 [Internet]. 2023 [cited 2024 Feb 8]. Available from: https://rcoa.ac.uk/gpas/chapter-10
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