| Title | The Impact of a Systemwide Policy for Emergent Off-Hours Venous Duplex Ultrasound Studies. | | Author(s) | Chaer RA, Myers J, Pirt D, Pacella C, Yealy DM, Makaroun MS, Leers SA | | Institution | Division of Vascular Surgery, Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. | | Source | Ann Vasc Surg 2009 Sep 10. | | Abstract | BACKGROUND: We evaluated the impact of an after-hours policy regulating venous duplex ultrasound (VDU) for deep vein thrombosis (DVT) diagnosis on resource utilization and patient care.
METHODS: On July 1, 2007, we altered the approach to emergent VDU of patients with potential DVT during off-hours (defined as 5:00p.m. to 7:00 a.m. weekdays, after 3:30p.m. Saturdays and Sundays). Instead of 24hr access, we permitted a venous duplex study in the noninvasive vascular laboratory (NIVL) only after meeting set criteria developed collaboratively across services. In the emergency department (ED), we based all VDU requests on a preset modified Wells score (MWS) as determined by the ED physician. Those patients with MWS 0 or 1 and those above 1 who could receive empiric single-dose low-molecular weight heparin (LMWH) received next-morning imaging unless consultation with a vascular surgeon created an emergent imaging plan. In parallel, inpatient emergent VDU was permitted only after contact with an attending vascular surgeon and where empiric short-term anticoagulation could not occur safely. We tracked NIVL utilization, patient morbidity, sonographer retention, and satisfaction.
RESULTS: The number of overall off-hours emergent VDUs decreased from 59 to 19/month after implementation. Testing was deferred in 52 ED patients: 15 stayed in the ED for testing in the morning and 37 were discharged to be tested the following day. Thirty-one of 37 patients returned for testing as outpatient follow-up. Twenty-eight received ED LMWH while awaiting testing. No adverse events were noted with the delay. The mean MWS for ED after-hours studies was 2.9+/-1.6 and that for deferred ER studies was 2.4+/-1.3 (p=0.005). Incidentally, overall off-hours inpatient and ED VDU requests decreased 64% with no clinical adverse events in the first year. The rate of overall positive studies done off-hours increased from 6.7% to 20% (p<0.0001). Sonographer satisfaction was maintained with regulation of call.
CONCLUSION: Our collaborative approach allowed off-hour VDU utilization to decrease without any measurable negative care impact. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19748216 |
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