title: Identifying inappropriate hospital stay in patients with venous thromboembolism.
abstract: Background: Traditionally, venous thromboembolism has been treated in a hospital setting. Nowadays, low molecular weight heparin (LMWH) preparations allow most deep venous thrombosis (DVT) patients to benefit from home therapy. The objective of this study was to evaluate whether the previous treatment of deep venous thrombosis in a hospital setting was appropriate in the context of modern opinion, using the Dutch Appropriateness Evaluation Protocol (DAEP). If so, the DAEP could be used to assess the appropriateness of the present hospital stay of other patient groups. Methods: A retrospective study of patients treated from 1995 to 1998 for DVT or for pulmonary embolism (PE), before the implementation of ambulatory treatment, was conducted that assessed the appropriateness of the patient's hospital stay using the DAEP. Results: Only 27.1% of the treatments for DVT were found to be appropriate in a hospital setting and related to specific hospital care. Inappropriate stay was mostly related to delays in hospital and discharge procedures. Of the patients with PE, 50.2% needed a hospital stay. This proportion was statistically significantly higher than in DVT patients (p<0.001). The extent of the DVT was not related to the length of bed rest prescribed. Conclusions: The DAEP was able to identify inappropriate hospital stay in the past within the DVT patient group. Further exploration of the potential of the DAEP to identify patient groups who could be treated at home is warranted.
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Post Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Lambert J.G.G.
authors.initials: LJ
authors.lastname: Panis
authors.forename: Dinanda N.
authors.initials: DN
authors.lastname: Kolbach
authors.forename: Karly
authors.initials: K
authors.lastname: Hamulyák
authors.forename: Martin H.
authors.initials: MH
authors.lastname: Prins