Aim The risk of a deep vein thrombosis (DVT) increases in pregnancy, occurring in 1–2 in 1000 women. The aim of our quality improvement project was to streamline and increase the efficiency of the assessment and treatment of Deep Vein Thrombosis in antenatal and postnatal (up to 6 weeks) women, presenting to the Maternity Assessment Unit (MAU) at St Thomas’ Hospital.

Method The maternity data collection system (BadgerNet, Clevermed Ltd) was used to conduct a retrospective analysis of women presenting to the MAU with symptoms suggestive of a DVT between July 2018 and March 2019. Staff were educated on the updates to Trust guidelines on diagnosis and management of DVT in pregnancy. The need for a doctor to review a patient prior to same day ultrasound Doppler scan was eliminated and nurses were given the ability to request an ultrasound Doppler if a woman met agreed criteria. A re-audit was completed between August 2019 and March 2020.

Results The elimination of a doctor review prior to same day ultrasound Doppler scans, reduced waiting time for patients and allowed doctors to assess with the complete clinical information. There has been a reduction in unwarranted clinical variance in the assessment and treatment of DVTs, with 78% compliance with the protocol (100% for same day scans, 62% for next day scans). 3 patients did not receive Low Molecular Weight Heparin (LMWH) according to the new protocol, one of which declined treatment.

Conclusion Clear, concise guidelines for staff reduces unwarranted clinical variation and ensures safer management of patients. The extension of the midwife’s role within the MAU provided midwives with more clinical autonomy and reduced delays in assessment and treatment. Assessment by a doctor prior to the ultrasound request did not contribute to improved patient care.