The impact of the development of a program to reduce urgent (off-hours) venous duplex ultrasound scan studies

Abstract

Objective: The purpose of this study was to develop a protocol for evaluation of patients suspected of having deep venous thrombosis (DVT) who came to the hospital after normal noninvasive vascular laboratory (NIVL) working hours in an attempt to both retain registered vascular therapists and provide excellent patient care. Methods: We developed a protocol for evaluation of patients suspected of having DVT who were seen at night after normal NIVL working hours (8 am to 9 pm). After exclusion of those with contraindications, all eligible patients either received low-molecular weight heparin (LMWH; 1 mg/kg) and were sent home or were placed at bedrest in the emergency department until the NIVL opened the following morning. Those sent home were given maps to the NIVL and told what time to report. Parameters examined were numbers of after-hours venous duplex ultrasonography (VDU) studies, patient morbidity and mortality, and RVT retention. We compared results from October 1, 1997, through September 30, 1998, the year before the program started, with those from October 1, 1998, through September 30, 2000, the 2 years after program implementation. Data were compared with χ2 analysis. Results: During the study period, 161 patients suspected of having DVT were seen at the NIVL after hours and were deferred for study until the morning. Eighty-eight patients received prophylactic LMWH and were sent home, and 73 patients were placed in observation. All had VDUs the next morning at 8 am. No deaths, pulmonary emboli, or immediate complications of anticoagulation therapy were seen. After implementation, we noted an 89% reduction in after-hours VDU studies. Before program implementation, four RVTs resigned during an 18-month period because of issues relating to excessive call. From 1998 through 2000, the NIVL had 100% retention of its nine RVTs. Conclusion: The development of the LMWH program has reduced after-hours VDUs by 89% without causing patient morbidity or mortality. Retention of RVTs has been 100% since program implementation. Copyright © 2002 by The Society for Vascular Surgery and The American Association for Vascular Surgery.