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Implementation of an acute DVT ambulatory care pathway in a large urban centre: current challenges and future opportunities
BACKGROUND: Ambulatory management of isolated acute deep venous thrombosis (DVT) is the recommended standard of care in selected populations. However, in practice a significant number of patients continue to be managed as in-patients. OBJECTIVES: In this study we aimed to evaluate acute DVT treatmen...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617851/ https://www.ncbi.nlm.nih.gov/pubmed/31333332 http://dx.doi.org/10.1186/s12959-019-0203-y |
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author | Kelliher, Sarah Hall, Patricia Kevane, Barry Dinu, Daniela Ewins, Karl MacMahon, Peter Ní Áinle, Fionnuala Breslin, Tomás |
author_facet | Kelliher, Sarah Hall, Patricia Kevane, Barry Dinu, Daniela Ewins, Karl MacMahon, Peter Ní Áinle, Fionnuala Breslin, Tomás |
author_sort | Kelliher, Sarah |
collection | PubMed |
description | BACKGROUND: Ambulatory management of isolated acute deep venous thrombosis (DVT) is the recommended standard of care in selected populations. However, in practice a significant number of patients continue to be managed as in-patients. OBJECTIVES: In this study we aimed to evaluate acute DVT treatment pathways in our emergency department (ED) in practice and to identify barriers to outpatient management. METHODS: This study was a cross-sectional analysis of prospectively collected data pertaining to consecutive patients presenting to the ED of a large, city center, academic teaching hospital over a 46 week period who were diagnosed with DVT. RESULTS: Implementation of an outpatient care pathway led to the majority of patients presenting with DVT in our institution being treated without hospital admission. Forty percent (31/78) of patients with DVT were treated with a direct oral anticoagulant (DOAC) as an outpatient in line with international best practice guidelines. CONCLUSION: The study provides a clear picture of the clinical profile and management of patients in clinical practice. Due to the lack of resources and supported infrastructure it is difficult to effectively implement outpatient venous thromboembolism (VTE) management to its full potential. Directing resources towards strategies which facilitate outpatient DVT treatment among vulnerable patient groups could represent a means of reducing hospital admissions for DVT in urban centers. Our study highlights the success and clinical limitations of the outpatient treatment model, which should become standard as part of wider VTE care. |
format | Online Article Text |
id | pubmed-6617851 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-66178512019-07-22 Implementation of an acute DVT ambulatory care pathway in a large urban centre: current challenges and future opportunities Kelliher, Sarah Hall, Patricia Kevane, Barry Dinu, Daniela Ewins, Karl MacMahon, Peter Ní Áinle, Fionnuala Breslin, Tomás Thromb J Review BACKGROUND: Ambulatory management of isolated acute deep venous thrombosis (DVT) is the recommended standard of care in selected populations. However, in practice a significant number of patients continue to be managed as in-patients. OBJECTIVES: In this study we aimed to evaluate acute DVT treatment pathways in our emergency department (ED) in practice and to identify barriers to outpatient management. METHODS: This study was a cross-sectional analysis of prospectively collected data pertaining to consecutive patients presenting to the ED of a large, city center, academic teaching hospital over a 46 week period who were diagnosed with DVT. RESULTS: Implementation of an outpatient care pathway led to the majority of patients presenting with DVT in our institution being treated without hospital admission. Forty percent (31/78) of patients with DVT were treated with a direct oral anticoagulant (DOAC) as an outpatient in line with international best practice guidelines. CONCLUSION: The study provides a clear picture of the clinical profile and management of patients in clinical practice. Due to the lack of resources and supported infrastructure it is difficult to effectively implement outpatient venous thromboembolism (VTE) management to its full potential. Directing resources towards strategies which facilitate outpatient DVT treatment among vulnerable patient groups could represent a means of reducing hospital admissions for DVT in urban centers. Our study highlights the success and clinical limitations of the outpatient treatment model, which should become standard as part of wider VTE care. BioMed Central 2019-07-10 /pmc/articles/PMC6617851/ /pubmed/31333332 http://dx.doi.org/10.1186/s12959-019-0203-y Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Review Kelliher, Sarah Hall, Patricia Kevane, Barry Dinu, Daniela Ewins, Karl MacMahon, Peter Ní Áinle, Fionnuala Breslin, Tomás Implementation of an acute DVT ambulatory care pathway in a large urban centre: current challenges and future opportunities |
title | Implementation of an acute DVT ambulatory care pathway in a large urban centre: current challenges and future opportunities |
title_full | Implementation of an acute DVT ambulatory care pathway in a large urban centre: current challenges and future opportunities |
title_fullStr | Implementation of an acute DVT ambulatory care pathway in a large urban centre: current challenges and future opportunities |
title_full_unstemmed | Implementation of an acute DVT ambulatory care pathway in a large urban centre: current challenges and future opportunities |
title_short | Implementation of an acute DVT ambulatory care pathway in a large urban centre: current challenges and future opportunities |
title_sort | implementation of an acute dvt ambulatory care pathway in a large urban centre: current challenges and future opportunities |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617851/ https://www.ncbi.nlm.nih.gov/pubmed/31333332 http://dx.doi.org/10.1186/s12959-019-0203-y |
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