title: A vascular laboratory protocol for improving and managing after-hours suspected acute deep venous thrombosis.
abstract: This study reviews the clinical and workforce impact of a suggested protocol designed for the management of suspected acute deep venous thrombosis (DVT) in patients seen after standard vascular laboratory business hours. The protocol included the use of Wells score, D-dimer and a single dose of therapeutic anticoagulant to defer venous duplex ultrasound (VDU) testing until routine business hours unless contraindicated. Information was collected on medical history, physical exam and the timing of any diagnostic studies and treatment provided. Over 15% of studies done after-hours were deemed unnecessary by our protocol and in every individual the results were negative for an acute DVT. There were no adverse events from a one-time dose of anticoagulant. Limiting emergency VDU coverage to evaluate for acute DVT based on a management protocol can eliminate unnecessary after-hours VDU testing without having a negative impact on patient care.
authors.affiliation: Vascular Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Angela H
authors.initials: AH
authors.lastname: Martin
authors.forename: George
authors.initials: G
authors.lastname: Eckert
authors.forename: Gary W
authors.initials: GW
authors.lastname: Lemmon
authors.forename: Alan
authors.initials: A
authors.lastname: Sawchuk
authors.forename: Michael C
authors.initials: MC
authors.lastname: Dalsing
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000592:standards; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000925:Anticoagulants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D002648:Child; D002985:Clinical Protocols / Q000592:standards; D003661:Decision Support Techniques; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D019564:Unnecessary Procedures; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D057188:Workflow; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; acute deep venous thrombosis; venous duplex ultrasound